Hello very wise ones!
     Saw a mom today who is by far a most challenging and wonderful client.
She gives permission to post and any suggestions or comments would be most
welcome.
Mom had fertility problems.  Three months ago, adopted a little boy at birth.
 She was approx 6 months pregnant at the time, so doctors advised against BF.
 Newborn daughter is 8 days old, C-sec, birth weight 5#7oz.  Has not nursed
well since birth (was cup and syringe fed ABM in hospital).  Hospital LC on
vacation.  Mom was given double pumping kit, but did not pump in hospital.  3
month old and newborn were in room with mom.  Mom is 40 yrs. old and has
Sjogren's, Rheumatoid Arthritis and Lupus.
     Meds now--just Tylenol and prenatal vitamins.   Double pumped a few
drops of milk.  Nipples extremely sore.  Baby has small mouth and has mostly
non-nutritive sucking.  Finger fed baby ABM and she sucked very well.  Taught
her how to use SNS at breast with plans to have both babies at breast
eventually.  She will pump as regularly as possible.  She has plenty of
household help for now.
     A search of archives looks good for BFing with RA and lupus, although
lupus can flare pp.  I found nothing on Sjogren's.  Ruth Lawrence says BFing
may not be successful.   Anyone have any info on Sjogren's?  Any ideas on
milk supply?  Mom is extremely motivated to breastfeed.
     What are your ideas on galactagogues?  Mom would rather go the herbal
route.
In view of the auto-immune disease, mom asked about the silicone nipples
(Avent) because she is using the non-silicone for the 3 mo. old now and it
may be harder to get him to the breast after those nipples.  TIA for your
comments and anxiously awaiting your replies.

Alice Ernest, LLLL, IBCLC
Simpsonville, SC

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