I believe I left this saga at the point where the baby was 5 months old
and by the mother's report, the primary MD was unhappy with wt. gain
pattern and unwilling to consider the possibility of hereditary factors
or weighing errors in earlier weights charted. The second opinion MD told
her that in fact some mothers DO have too few calories in their milk -
she KNEW because it happened to HER. The mother had no real choice in
health care except to use this facility.
The mom (with mild CP) had been forced to sign a contract not to
breastfeed at all (not even for comfort) for 2 weeks, with all feedings
to be of ABM, to which the mother decided to add 1 tsp. cereal to each
bottle. (This stopped the reflux.) The MD approved her decision.
After the MD's warning (read "threatening"?) the mom that the baby might
have to be hospitalized if not at least 13# by the next visit, she
continued pumping but fed ABM, 6-7 bottles daily, round the clock. Her
freezer was so full of pumped milk that she discarded the older milk in
order to freeze what she kept pumping.
Several tests to rule out UTI and other infections were done at the next
appointment. When the baby did reach 13.5 # on the enforced ABM feedings,
the MD began "permitting" her to nurse for comfort from 7 p.m. to 7 a.m.
That of course placed the ABM feedings during the hours when she had sole
responsibility for the toddler as well as the baby, without her husband
home to help with the manual dexterity that might be needed in giving the
bottle. >
>
The mother is currently gone for 10 days on vacation to relatives she
feels are unsupportive. Perhaps her enforced regimen may turn out to be a
blessing in disguise, as she can bottlefeed in the daytime when and where
they can see her, and breastfeed in privacy during the night.
This family is so dependent on this health care system, with which the
WIC program has no direct influence, that to prevent increased stress on
the family, we felt it was best to validate her courage and devotion,
provide her accurate information and support, but let them manage the
interaction with the physicians.
There were some (no doubt younger and less battlescarred than I) who were
so incensed by this case that they wanted one of us at WIC to sort of
charge in on a white LC steed and try to rescue the situation.
In my experience, that would have made the physicians defensive about
their obvious ignorance regarding certain aspects of breastfeeding, and
perhaps become more punitive to the mother. It would have further soured
relationships between that facility and WIC that would be harmful to
future patients.
We may ultimately decide to provide the mom with a printout of all the
responses received, and the name of a breastfeeding-friendly local
lawyer, and let the family decide what to do or not do in relation to the
physicians.
Thanks to all who responded.
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio
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