This is a lengthy post, regarding a difficult case, any suggestions would be
appreciated, If more details are needed, I will be happy to fill in.
Thanks!
>
>
> The baby was born on February 6 weighing 6#14 oz. Mom had a vaginal
> precipitous delivery with extensive tears, after 2 hours of attempted
> repair with heavy bleeding, they took mom back to the OR for repair. She
> did not have a retained placenta, and had no D/C. Because of the bleeding
> baby did not nurse in the delivery room, at about 4-5 hours post partum
> infant went to the breast for the first time ( no supplements in NSY) Mom
> had a pre delivery breastfeeding class where she informed me that she had
> little increase in breast size during her pregnancy. She had increased
> just barely a bra size at the beginning of pregnancy and no more after
> that. She gained 32lbs during her pregnancy.
>
> Baby was exclusively nursing , at pediatrician office
> 2/11 weight was 6# 10oz (with diaper on? go figure)
> 2/13 weight was 6#9 oz ( again with diaper on)
> pediatrician then gave mom formula to supplement after feedings.
> Pediatrician then advised mom to supplement with either expressed breast
> milk or formula twice a day, two ounces each time. The baby spit up much
> of the initial formula supplement there in the office. Mom called the
> lactation consultants that afternoon for help.
>
> On 2/13 he was nursing at least 8 times during awake hours and mom was
> setting the alarm for no longer than 3 hours at night. Since he was not
> able to take the full 2 ounces of supplement without spitting up, it was
> suggested that mom give 1 ounce after nursing for 4 feedings a day instead
> of 2 full ounces at once twice a day, and to pump after feedings. This
> along with breast compression during feedings and skin to skin.
>
> On 2/16 Mom spoke again with an LC. The baby had gone to the pediatrician
> again and baby had gained one ounce in 3 days. He was taking only 1 1/4
> ounces of formula when offered but would take 2 full ounces of breast milk
> when offered. The pediatrician suggested mom try Fenugreek, Alfalfa and/
> or Mother's Milk Tea. After speaking with the LC mom decided on Fenugreek
> and Blessed Thistle. The pediatrician demonstrated cup feeding because
> mom had noticed more difficulty getting infant to latch.
>
> On 2/17 I saw mom for a feeding assessment and consult. His naked weight
> was 6# 5.9 oz. His feeding was low, and swallowing was seldom even with
> compression. We used a supplemental nurser at the breast and infant gained
> 1.2 ounces during that feeding, 10cc of which was supplement. I offered
> suggestions for a deeper latch and the use of supplemental nurser during
> the feeding instead of feeding after feeding. I also advised mom pump
> after feedings and had her pump here in the office so that she would have
> the supplement for the next feeding. Mom was started on an electric double
> breast pump, 15 minutes of pumping after each feeding. I advised using
> 30cc expressed breast milk via supplemental nurser at each feeding and to
> return in 3 days. The plan was to decrease the amount of supplement every
> 24 hours as the baby took more and more at the breast so that the
> supplement was weaned over several days.
>
> A different consultant saw mom on 2/20 ( I was out of town) No naked
> weight was obtained, he took about .9 ounce at the breast with out any
> supplement, plan was to continue using one ounce supplement with each
> feeding. Mom was giving 20cc expressed breast milk with each feeding and
> pumping after feedings, the exception to this was the night feeding which
> mom did not pump after and 20cc formula was given. All via supplemental
> nurser at the breast.
>
> On 2/26 I saw mom again for a follow up visit. Naked weight was 6#9.8
> ounces, intake at the breast was 1.7 ounces and mom was still taking the
> Fenugreek, however, she was not noticing any difference in odors and since
> there had been little increase in weight ( 3.9 ounces in 9 days) I
> suggested mom increase her fenugreek dosage as well as gave information
> regarding Domperidone and Reglan.
>
> On 3/1 Infant weighed 6#11.3 (2.2 ounces in 4 days) However, intake at
> the breast had not increased and mom was supplementing with a small amount
> of formula almost every feeding since she was not pumping that much milk.
> She still had no odor change from the Fenugreek and I strongly advised she
> consider the Domperidone. She started the Domperidone on 3/2.
> Unfortunately mom also started the mini pill on Monday 3/1 ( un beknownst
> to me until later)
>
> On 3/4 infant weight 6#12.5 ounces, He was getting 20cc supplemented at
> the breast (EBM) every feeding except for the night feeding which he got
> 20cc mix of breast and formula. Mom was pumping after feedings. This
> observed feeding the infant took 1.8 ounces at the breast with no
> supplement, a marked increase over past feedings. She had only been on
> Domperidone for 24 full hours and this is when I learned of the mini-pill.
> I suggested she consider discontinuing the minipill since her supply was
> already compromised. Mom did discontinue the mini pill at that time. The
> plan was to decrease the supplement to 10 cc each feeding and use EBM only
> and continue pumping after as many feedings as possible, and to continue
> nursing frequently. The infant has continuously been nursing 9-10
> feedings/24 hours
>
> Today 3/10, Baby weighs 6#14.8 ounces naked. Finally back to birth
> weight. Mom states that she started her menstrual bleeding on Friday the
> day after she quit taking the minipill. I have suggested that mom
> discontinue supplement at the breast to see if the infant will continue to
> gain at the breast alone.
> Do you have any further suggestions. Do you think her supply has been
> permanently compromised? The latch looks very good but the infant is
> still a sleepy nurser and breast compression is used throughout all
> feedings. I can see no oral issues with this baby, and mom has round
> breasts with an everted average diameter nipple and soft areola, not thick
> and hard.
>
> I appreciate your help, sorry for the lengthy detailed note but I wanted
> you to have a good picture of what I am seeing.
>
>
Pam Price IBCLC, CBE,
Lactation Department Coordinator
2nd Floor, Trident Medical Center
9330 Medical Plaza Drive
Charleston, SC 29407
(843) 797-4554 Breastfeeding Help Line
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