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Date: | Thu, 19 Mar 2015 06:41:01 +0000 |
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Rachel
You relate a very difficult postpartum course for a mother pumping
for 2.5 months for multiples in the NICU. It actually sounds as if
the amount of pain she has experienced while pumping is so over the
top that I'd be wondering whether she was suffering from postpartum
depression. I recently heard Alison Stuebe speak in Spain and she
described research she's involved in looking at pain in relation to a
mother's emotional state. Even without medicalizing this mother's
distress, having multiples in the NICU for this length of time must
be incredibly hard and exhausting. Would it be an idea for her to
ask her own physician about the adviseability of a
breastfeeding-compatible anti-depressant? This might not only enable
her to cope a little better but may also act as something of a
galactogogue, a frequently experienced side effect?
You say that she has "chosen" to wean, presumably due to the hassles
and the pain associated with pumping for this length of time ....
but has she any conception of how important her milk is to her
fragile babies? There would seem to be a clear conflict of interest
in this situation between the needs of the mother and the needs of
the babies. But truly, the mother is all grown up and the babies are
at risk of infections/NEC etc now, and lifelong disadavantages if she
puts them on formula now. I don't know if you have any
handouts/literature to help mothers make these decisions and bolster
their resolve - but she deserves to know the truth???
Just my 0.2ml.
Pamela Morrison IBCLC
Rustington, England.
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Date: Wed, 18 Mar 2015 14:38:01 +0000
From: "Cruz, Rachel (NICU)" <[log in to unmask]>
Subject: lecithin dosage
Hello All,
Permission to post: I have a patient who has had multiple bouts of
plugged ducts, mastitis and damaged nipples in pumping for the last
2.5 months in the NICU for her multiples. She has used a Medela
Symphony pump and felt too much pain. She currently uses a Spectra
pump and feels that the pulsatile action of the pump is the most
tolerable. I have been a NICU LC for 6 years and I've never had a
patient with this much pain. We have tried all the usual-adjustment
of flange size on many occasions (uses a 27-30mm flange) as well as
use of Lanolin cream with pumping (not anymore), hydrogel pads, APNO
cream after all pumping sessions and a course of 7 days PO
antibiotics which is now finishing today. She uses heat before
pumping and deep massage during all pumping sessions as well. (She
watched the Morton videos)
She has pumped for 10 weeks and is now choosing to wean. She has been
taking lecithin 4800mg daily which helped at first but is now only
helping minimally. (This was started when plugged ducts initially
began several weeks ago). I cannot find information if a higher dose
of lecithin is safe. Please advise wise ones! Also, any other advise
on the above mentioned scenario would be appreciated.
Rachel Cruz, RNC-NIC, IBCLC
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