Hi Ivy,

Well, what an ordeal for both of them to go through! My first thought
is that she is making more milk than I really would have expected, so
that is a big positive. You have a couple of serious things going on,
however. The first is that the follow-up care, which would be
extremely critical in such a dire (for both mother AND baby) case, is
not sufficient. The baby's weight gain and overall condition, stamina,
etc needs to be evaluated in person and with accurate tools. If there
is any way you could arrange that, I would make it a priority. Even
with your cold, provided you felt better but were worried about
exposing them, I think I would put on a mask and good handwashing and
get over to see them if I could.

Even with the pees and poops, I have seen babies who are losing or
just staying the same weight for days and days. And I've seen many
babies weighed incorrectly or with various clothes or diapers on at
various weigh-ins.

The other issue seems to be cultural, or just meeting mama where she
is. I would continue to counsel the mother to feed the baby generously
(at least until someone can evaluate baby's situation). Of course we
worry alot about parents diluting infant formula. If she believes
formula causes "heat" then I would try to say very authoritatively "It
is best not to mix extra water with the formula. You are giving
breastmilk or breastfeeding every day. That provides all the water the
baby needs." or "All baby needs is 2 sips of water (boiled, sterile)
to counteract the heat of the formula." Something like that. In other
words, allowing her cultural beliefs but protecting the baby's health
and safety. It appears she really does not want to, or feel
comfortable with, an SNS or finger feeding. So go with the bottle and
perhaps give her some tips about bottle feeding in a bf-friendly way.

It is not fair that you have to be the only one following this dyad;
it puts a great burden on you. I don't know who you could enlist to
help you with follow-up? Someone from the public health sector, a
midwife? I'm not remembering everything you said about the healthcare
system there. Hope this helps in some way.

Laurie Wheeler RN MN IBCLC
Mississippi USA

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