Heather wants an example of what circumstances might justify a test weight.
I saw a baby the other day whose mother was an experienced lactating mom,
who has really long nipples. Baby was 6 weeks old, and has gained only 10
oz over birth weight of 8.4oz. Mom finally called for help. Baby had been
seen at pediatricians within the past 5-6 days. Even though I assume there
will be some scale variance, I wanted to see where the baby's current wt
was. Baby's weight was down two oz from where it had been almost a week
earlier. My thinking on this is: " Hmmmm. And we are about at the point
where maybe this milk supply isn't going to remain ammenable to upward
regulation if we don't insure better stimulation and milk removal."
Visual assessment revealed a depressed, lethargic baby feeding with closed
eyes, scant swallowing. Small mouth/real receding chin, having difficulty
getting back behind these long nipples and over the milk sinuses. Breasts
are flaccid. Several attempts at repositioning finally achieve a good
latch. Attributes of good latch pointed out to mom, who grasps these
concepts immed. Baby allowed to feed in this position for 20 min. on one
breast. Swallows noted for about 4 min. Then eyes closed and a more
non-nutritive sucking rhythm was observed. This pattern persisted even when
baby was again re-positioned. Test weight performed . Intake revealed to
be 16 ml. Mother has been feeding "non-stop" for 6 weeks, and even with the
repositioning this is all baby was able to make happen at this feed. Maybe
this milk supply is so depressed this is all there is.
So yes, this is an occasion when a test weight will be an indication for
supplementation. I set up a pump, and pumped another 10 ml from the nursed
upon breast, and about 20 ml from the other side. All this was fed to the
baby. Mom had some frozen milk, so we thawed that and fed that to baby as
well (another oz). I used a bottle. Why? Because with such a long
maternal nipple, an SNS would still position the baby out on the nipple
shaft, and the breast still wouldn't get stimulated. There is less risk of
"confusion" due to super-sign stimulus of bottle teat with such a long
nipple, altho there IS risk of preference to ANY method which manages to get
liquid into this baby more easily. So that being the case, I chose the
fastest, easiest method for the mother. I figure we can deal with the
confusion after we stabilize the baby and the milk supply. Baby was given
the pumped milk and her eyes opened, and her affect became more alert and
responsive to interaction.
PLAN: Feed generously to help baby catch-up. Mother was instructed to jump
start with pumped breast milk (and formula if short on her milk) and nurse
ad lib. As milk supply regenerates, begin to taper bottle use. My goal is
to stim. milk supply with pumping and better emptying, herbs, and better
maternal nutrition and stress reduction. As baby gains weight and energy I
expect suck to improve, and fit between mouth and nipple to resolve. The
only real wild card is can we bring back such a depressed milk supply 6
weeks out, when it was never really established? Knowing about how much
baby took in helps me recommend approp. amount supple. for catch-up growth.
By the way, mother felt extremely validated by the test weight. She had
been so worried, and all her support system had been accusing her of having
post-partum depression. She said: "I'm not crazy. There has been
something wrong here all along, and now I know what it is, and maybe now we
can fix it." Her only regret was not jumping on the problem earlier.
Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates, Austin, Texas
http://www.jump.net/~bwc/lactnews.html
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