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Date: | Thu, 9 Jul 2015 07:43:38 +0100 |
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Laura
What a wonderful case history you've given......
except you don't give the baby's weights. I find
that underweight babies simply don't breastfeed
well. And they don't breastfeed well until they
regain the weight they should have put on if all
had gone well right from the beginning. If you
could send this baby's birth weight and current
weight, maybe it would give us more of the
picture. Meanwhile 21oz a day, 630 ml, does not
sound a lot of milk for a weak-ish baby to be receiving.
Also, just one more thought - is it at all
possible that while mom can let down to the pump,
she can't let down to the baby and that's why
you're not seeing any milk transfer without the
SNS? I know this is very unusual, but I had a
client once who experienced this, so it does happen.
Pamela Morrison IBCLC
Rustington, England
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Date: Wed, 8 Jul 2015 16:02:35 -0400
From: Laura Spitzfaden <[log in to unmask]>
Subject: Milk Transfer Difficulties
PTP. I am working with a mom of a 3.5 month old.
This is her second child. She had difficulty with
her milk supply with her first so she sought me
out as a LLL Leader when her newest baby was 2
weeks old and not gaining well without supplementation.
She has reactive hypoglycemia, so I shared
information with her about insulin resistance and
myo-inositol. This seemed to help significantly
with supply but she was pumping and using a SNS
to feed because her baby was not transferring well without the help of the SNS.
She decided to see me as an IBCLC when her baby
was 6 weeks old. Baby had some cranial molding
and a tendency to turn to one side. She had a
choppy suck and did not much engage her
temporalis muscle while feeding. She also had
restrictive lingual and maxillary labial frenums.
She did not transfer well at the breast though
Mom had available milk. She only transferred well with the SNS.
Mom followed through with multiple visits for CST
and a frenectomy of both restrictive frenums. I
have had excellent experiences with both
providers. The CST provider thinks that Baby is
dependent on SNS and is not used to working for
the milk. I feel like there is more to it.
A follow-up visit showed improved tongue mobility
and good sucking on a finger but I could feel a
lot of pressure on my finger from Baby's upper
gums. Transfer was not any better.
Mom is still pumping 9x a day and feeding 9x a
day with the supplementer at 3.5 months. Mom
reports that when she tries to challenge Baby
with slower milk flow from SNS, it results in
poor transfer for the rest of the day. Mom weighs
before and after feeds with a scale sensitive to
10 grams which is not ideal for accurate transfer
amounts but gives a pretty good picture and the
amounts transferred correlate well with weight gain.
Mom has tried goat’s rue, iron, b12, magnesium,
and moringa but did not have success with these
increasing supply. She has only had success with
the myo-inositol. She recently increased the
amount she takes and it has given her a boost in
supply. She produces a total of 21-24 ounces a
day and supplements with 1 or 2 ounces of formula
every few days to maintain weight gain.
Does anyone have any suggestions for continued help for this dyad?
Laura Spitzfaden, LLLL, IBCLC
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