I saw two similar and very sad situations today -- what my friend Judy
Eastburn calls "train wrecks."  Baby #1 down 15% of birth wt. on day 14.  Mom
has hx of gest. diabetes, late onset lactation (Day 6 and then only mild
engorgement.) No one gave her a pump -- she's been sporadically hand
expressing.  Baby induced at 37 wks, 1st epidural placed "too high" and after
repeated boluses failed to numb her out, a pudendal block was done.  Baby was
vacuumed out and has huge -- and I do mean huge -- cephlahematoma.  He can't
stand to be touched, has a choppy disorganized suck, and sleeps constantly.
 Nothing I did helped and mom got sadder and more upset as we went along.
 Finally I said lets just pump, try to get baby to breast to practice at
every feed, skin-to-skin, water nursing, using sns, sns threaded under
shield, etc all the things we tried.  Baby would finger feed with sns and
will take bottle (pedi initiated bottle feeds of formula yesterday.)  When I
pumped her she has almost no milk.  She was ref. by the pedi and we are
authorized to see her twice under a co-pay deal, but when we phoned the HMO
to ask about the feeding tube device and the pump, they refused the equip.
 The clerk at the HMO said "A breast pump.  That's like a diaper bag.  I'm
not going to authorize that."  This mother has no money.  I gave her the sns.
 Which is not a sustainable solution, obviously.  I begged her to find the $
for the pump kit and told her I'd get her the pump on the scholarship, but
she was so upset by then she just left.

Baby # 2 was another induced 37 wk old, down a lb from birth wt at 7 days pp.
 Mother has hx of depression and hypertension, milk in on day 5, also only
mild engorgement.  This kid has a huge scab on her head from the fetal
monitor, and is totally shut down too.  Never opens her eyes. Mom on iv
epidural for hours prior to delivery. Baby was distressed at birth, given
oxygen because she was blue -- mom doesn't know apgars.  This mom has a
Ger--- pump and no money.  Same deal.  I managed to get her out the door with
a pump.

What I want to know is does anyone still get to deliver when they go into
labor on their own, or is everyone induced now at 37 weeks?  Are all these
drugs absolutely necessary?  Why don't these 'pain-free' childbirths make for
happier mothers post-partum?  Why does it take so long to get these mothers
referred for bfg assistance?  And WHY does some clerk who knows nothing have
the power to deny the mother of a failure to thrive infant the equipment to
salvage breastfeeding?

Thank you all for listening.  It's been a frustrating day.

Barbara Wilson-Clay, BSE, IBCLC
priv. pract. Austin, Tx