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Subject:
From:
"Steve, Sue & Eliza" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sun, 14 Sep 2003 22:34:09 +1000
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Dear Wise Ones

My name is Suzie Heaton.  I have been a Lactnet lurker since early this
year.  I am a breastfeeding mother to 2, DD aged 3 years and DS 5 mths.  I
hope to become an ABA counsellor and eventually an IBCLC.  The (not so)
small matters of a degree and lots of experience should be resolved by 2009
allowing me to aim for IBCLC exam in 2010.  I try (mostly unsucessfully) to
convince myself that it doesn't really seem like a long time. In the mean
time I am studying breastfeeding online with two lovely IBCLCs.  My thanks
go to them and to all on Lactnet who, by sharing so willingly, increase my
knowledge daily.

I am very daunted about posting for the first time given my complete lack of
experience.  However, I have found myself in a situation where I am helping
an email list aquaintance, who has just given up breastfeeding and who is
interested in going back to breastfeeding.

I suspect the mother's two main issues are 1. how hard will it be to get the
baby back to the breast and 2. can the problems that caused her to wean to
bottle be overcome.

I do have the mother's permission to post.

Main Details (further details included in mother's message at end of email):

Baby boy born 12th August 2003
Born at 37 weeks 1 day gestation
Comp fed "with tube in special care " and by supplementer and cup.  Baby had
jaundice but I'm not sure what other problems.
Mother has PCOS and history of undersupply with first child so LC commenced
reglan at day 3
when "milk had not come in"
Baby lost 200g and returned to birth weight at day 9.
Mother stayed longer in hospital to get breastfeeding established.

                    weight                    length
birth              3020g (6lb 8oz)    50cm
2 weeks        3440g (7lb 9oz)    51cm
3 weeks        3760g                   52cm
4 weeks        4080g (9lb)          54.5cm

At 2 weeks baby was having 9 or 10 dirty nappies a day.  Mother was still
concerned about supply.

Mother decreased Reglan (1 of 3 tablets) on day 10 resulted in "feeding
frenzy"
the next day.  If I understand correctly she stopped Reglan around day 22 or
23.

Mother commenced Fenugreek around 18 days (she had used this with success
with first child).  She ceased fenugreek about day 28.

Mother has mentioned that she switched breasts lots.

Baby has been very unsettled and feeding lots particularly at night.

Mother stopped breastfeeding at approximately 28 days.  She continued to
express until day 30, getting dwindling amounts and down to 100ml  on day
30.  Did not express on day 31 or today, day 32 (as of early pm today).
Breasts no longer
feeling full, sore or leaking.  Baby will only attach for 1 or 2 sucks each
side.

Family lives in a rural town 1.5 hours drive from Melbourne, Australia.
They are
unable to travel to Melbourne to see an IBCLC.  Mother states local public
hospital LC was helpful while she was a patient but that LC is too busy to
see her now she has been discharged.   She did try to see this LC when she
had problems with child #1 but LC was too overwhelmed with inpatients.

I realise that I have no experience.  However, it seems to me that
- between the mother and the LC, the mother's supply came up really well,
weight and length gains show that the baby was indeed getting plenty of
milk.
- not following the "finish the first breast first" practice lead to a
foremilk/hindmilk imbalance which resulted in an unsettled baby, who had
"feeding
frenzies", and an exhausted mother
- by "finishing the first breast first" and using breast compression, skin
to
skin contact etc, perhaps with fenugreek the problems could have been solved
and allowed the mother to gradually withdraw the Reglan.

I would really appreciate comments as to whether the above summary seems
reasonable or if I am missing something.  Suggestions as to how to get the
baby breastfeeding again and what sort of time frame the mother would be
looking at would also be appreciated.  Although she certainly sees the
benefits of the breast she is very tired, dealing with a 2 year old as well
and only has limited capacity for going back to the breast (ie. if it gets
too hard she won't be able to continue).

I am fully aware that I am out of my depth in this situation and I feel bad
for asking you all.  However, as the mother seems keen to get back to
breastfeeding I feel that perhaps my inadequate support is better than none.
Mother would willingly receive email or phone support so perhaps the best
thing I can do is get her to contact the local Australian Breastfeeding
Association counsellor?

When I last spoke to the mother this afternoon we discussed going back to
expressing, lots
of skin to skin contact without pushing bub to latch, and re-instating
reglan or fenugreek (whichever she was comfortable with).  Mother only has
shallow bath available so is unable to bath with baby.  She is going to look
at hiring a pump from ABA or local chemist tomorrow.  I have told her that
this evening I will give her lots of info on boosting supply and
relactation.  I will forward some websites (such as Dr Jack Newman's breast
compression info), relevant info from The Breastfeeding Answer Book along
with any other information I feel would be helpful.  She and I both look
forward to any other suggestions.

Please reply to me personally at [log in to unmask] if it is not
appropriate to respond to the list with this query.

I have included a personal email from the mother below in case there is
more info necessary than I have included above.  Again, I have the mother's
permission to post this.

Thanks in advance for any replies.
Suzie Heaton

NB: Christopher is now 2yo, Alexander is the baby"
"1. Did you breastfeed Christopher?  How long, how did it go? Yep, he was
trouble but things improved by the time he was about 4 months and then
dwindled down hill by 6, kept detatching to watch flies walk up the wall or
any other minor destraction. We went to Tweedle(sleep school) when he was 6
months after he\d been on bottle for a couple of weeks to sort out sleep
issues. Because he so frequently feed during the night he slept in my arm to
sleep, never feeding just snuggling, always woke up and sat up to feed.

2. Have you had breast surgery? Nope

3. I'm assuming you've got PCOS but can you confirm?  Any other health
problems, such as thyroid?
Does being completely frazzled count? Am a definite on pcos, pretty classic
case, we have the weight, the hair, the insulin resistance levels are high,
and my ovaries are rotten, esp left. same as left breast, they are both
rotten performers.

4. Did you experience breast changes during pregnancy? Not this time, Had
leaking with number one.

5. How was labour and delivery? Waters broke at 3am light contractions that
went away. Syntocin started at 10 and baby born by 12:30pm Very easy labour
though even though we got stuck on the bed and couldn't get off. I had
pre-eclampsia and was in hospital a bit over a week before the baby was
born. The day before he was born we got offered the option of a 'c' section
or a trial labour the the day after he arrived. pleased he came when he
wanted to. Lucky  because my blood pressure had nearly caused a couple of
emergency 'c's to be arranged. Had very high protien levels so in labour got
stuck with a magnesium drip as well.

6. Was the placenta complete? Yes, they actuall pulled it apart and found
some grey patches from early bleeding, weeks 6-11 due to our complications.
We had ovarian hyperstim at the start of pregnancy and spent 8 days in
hospital with this as my kidneys weren't working well, and i looked 9 months
pregnant with all the fluid. Had 5 eggs make it down, two never did
anything, one made it to six week size but never got to see a heartbeat.
Another only made it to six week size, got to see heartbeat but never grew,
at 10 weeks we lost our 'twin'. Of course Alexander was egg number 5.

8. Did you milk "come in"?  Were you engorged? Nope and never.

9. Alexander: When was he born? 12/8
What gestation was he born? 37 weeks 1 day
 Was was hisbirth weight and length? 6lb 8oz 3020gram
What other weights and length measurements do you have (including
initial weight loss, when did he regain birthweight, more recents weights)?
Lost about 200 gram. Took fortnight to regain weight. He was comp fed
formula in hospital. Had a tube in special care and did some cup feeding, as
well as putting the tube alongside nipple.He's now 4080gram or 9lb and he's
grown 4.5cm since birth.
Did he have any jaundice? Yes spent 16 hours underlights on day two.
Christopher lost more and spent 36 hours under lights, this is why we comp
fed when we did.

10. Have you had any nipple pain or damage?  What was the shape of your
nipple immediately after detachment? Not really, slightly elongated.

11. Alexander's behaviour: sleep? contented? alert? meeting milestones?
fussy? crying? He's fairly  good now, although last night he was out of
sorts, sad wouldn't sleep. today he's been a little chucky. has had a few
good nights though of four hour sleeps lately.

12. Feeding behaviour: were you demand feeding?yes
 how long were feeds? about 10 minutes a side
 how often were feeds? anywhere from half hour to hour to a max of maybe 3
hours
could you hear or see him swallowing? yes
 what was his behaviour like while he was at the breast? was pretty good,
now just keeps pulling off after one suck if he will get on at all.

13. Are you on any medications? No, had plans of going back on to full pill
and met at 6 week check
 What amount of maxalon and fenugreek were you on and for how long? Two soup
spoon full a day, one morning one night of the fenugreek seeds, last time I
only used a teaspoon and that had me 'fuller'. I did 3 maxalon a day, tried
going down ut with no luck.
 What happened when you tried to come off it? Constant feeding frenzy by
next afternoon.

14.  How has your health been since Alexander's birth? Frazzled, doctor is
keeping an eye on me emotionally.

15. What have Alexander's stools been like - frequency, constistancy,
colour?  How has this changed over time? gone from every nappy when we came
home was a runny poo, to slightly less runny poo perhaps 4 a day now.

16. How many wet nappies did Alexander have in a day.  Was the urine light
yellow/colourless or mid to dark yellow? He's in disposable so is hard to
guess but they are light in color and going through about 6 to 8 huggies a
day.

17. What was the circumstances that lead the lactation consultant to
prescribe maxalon? History and fact milk hadn't come in. With comp feeds he
still lost 200 grams.

Well this is the story so far. Am willing to put some effort into this but
addmit it needs to be a fairly easy road as I am running out of energy and
this bottle thing has been rather convenient. Today both breasts are soft,
no soreness, no leaking at all. Tried attatching him last night and he gave
a couple of sucks and pulled off. Did this on both sides.
Am happy to gain any advice you have to offer."

             ***********************************************

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