Hi Tanya, I really agree with the other comments about skin-to-skin, early BF, and avoiding chilling. I don't agree with your director's ideas, but if you can't change his/her mind this may work for you. There is a soft 2 ml dropper that can be used for finger feeding. I teach the dads to do this because they don't have to wear gloves and they have short fingernails. Have the dad encourage the baby to suck on a finger and then slide the dropper in next to his finger and the baby will pull the colostrum out of the dropper. Parents that are not wanting their baby to bottle may accept this. Good luck with the change process! Sincerely, Rachel Wahl> Date: Fri, 16 May 2008 13:51:55 -0400> From: "Cheney, Tanya" <[log in to unmask]>> Subject: Supplementing the Hypoglycemic Newborn> > I want to find out what other hospitals are doing about initial low blood=> sugars on newborns when parents do not want bottles used. =20> > There is no expressed colostrum because the mother just delivered (yes, I=> know some may recommend that she pump at 38-40 weeks prenatally if her b=> aby is at risk for hypoglycemia, but our docs won't go there). At this t=> ime, our director is not willing to allow nurses syringe or cup feeding d=> ue to the risk of aspiration or perforation of the palate. We have many => new nurses who have not been trained or are comfortable doing this anyway=> =2E When I suggested paced bottle-feeding with a slow-flow nipple, manag=> ement frowned because the baby needs to be fed quickly to get that sugar => up. We are a busy hospital and do not have 24 hour-a-day LC coverage. A=> ny suggestions on how to please the parents who don't want bottles used w=> hile treating their hypoglycemic newborn?> > =20> >=20> > Tanya E. Cheney, RN, BSN, CCE> > Lactation Consultant=20> > Hampton Roads Area of Virginia> Taking IBCLC exam in July> > - writing a third post on Lactnet and finding out it is not as scary as o=> nce imagined . . .> > > > > > > CONFIDENTIALITY NOTICE: This e-mail message, including any attachments, i=> s for the sole use of the intended recipient(s) and may contain confident=> ial and privileged information. Any unauthorized review, use, disclosure => or distribution is prohibited. If you are not the intended recipient, ple=> ase contact the sender by reply e-mail and destroy all copies of the orig=> inal message.> > ***********************************************> > Archives: http://community.lsoft.com/archives/LACTNET.html> To reach list owners: [log in to unmask]> Mail all list management commands to: [log in to unmask]> COMMANDS:> 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail> 2. To start it again: set lactnet mail> 3. To unsubscribe: unsubscribe lactnet> 4. To get a comprehensive list of rules and directions: get lactnet welcome> > ------------------------------> > Date: Fri, 16 May 2008 14:12:25 -0400> From: Brenda Phipps <[log in to unmask]>> Subject: Low milk supply - related to radiation?> > I'm working with a mom of twins in our NICU - she has never been able to=20=> > express more than 5ml at a time, even when switching to the Symphony pump=> =20> and providing larger flanges. She has never felt a large milk surge. She => did=20> receive radiation to her spine as an 8 year old for leukemia (which is no=> w in=20> remission). Could this radiation have effected her milk production, even => though=20> it was not directly on her chest?> > Thanks,> Brenda Phipps, BS, IBCLC> > ***********************************************> > Archives: http://community.lsoft.com/archives/LACTNET.html> To reach list owners: [log in to unmask]> Mail all list management commands to: [log in to unmask]> COMMANDS:> 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail> 2. To start it again: set lactnet mail> 3. To unsubscribe: unsubscribe lactnet> 4. To get a comprehensive list of rules and directions: get lactnet welcome> > ------------------------------> > Date: Fri, 16 May 2008 11:26:50 -0700> From: gonneke van veldhuizen <[log in to unmask]>> Subject: Re: Send me your breasts...> > www.intermediairforward.nl/artikel.jsp?id=1342715> Text under poster: ''breastfeeding: kind of important''. Text in balloon: ''No, no further sexualising of society, this is functional nudity''> Comic in answer of a pro breastfeeding campaign by the Dutch minister of health Ab Klink> http://www.debakermat.be/Tijdelijk/Borstvoeding.jpg> Bill board for a Belgian medical insurance company. Text: ''Ofcourse you can make money by showing your breasts'', breastfeeding mothers can get a bonus from this insurance company.> I like this one: > http://www.zorgvoorborstvoeding.nl/php/page_1.html> Celebrating 10 years of ''Zorg voor borstvoeding'', =BFHI in The Netherlands> > This one I like most: http://www.zorgvoorborstvoeding.nl/files/WbW07_BorstvPosterA2.pdf> It's the WBW poster 2007. The mom is a LLL leader. Once LLL got a mad letter via a laywer from a mom who claimed to be the mom at the picture and wanted to sue for braking image rights. So far for knowledge of own body and baby!> > > It is hard to find something in my language area: most breastfeeding promotion is about the baby/infant/child, not about the breast.> > > Warmly, > Gonneke, IBCLC, LLLL in southern Netherlands> > Morgan Gallagher <[log in to unmask]> wrote: As a result of responses to my analysis of some breastfeeding posters, > I've ended up in the middle of several discussions about semiotics and > iconography of breastfeeding posters. The difference between intent > and effect.> > So, I feel a much longer post brewing, where I post out a lot of > images, and say which ones do sexualise breasts by construction, which > ones don't etc et etc.> > So, could you send me your breasts? ;-) > > Or rather, your favourite, and most hated, breastfeeding support > posters. Or ones you are undecided upon? Any and all, in fact. I have > a small gallery already. You need to send them to me as a JPEG, and to > morgan@dreyfuss.demon.co.uk..> > And if ANYONE has a good sized image of both the bare breasts posters by > INFACT, the one just referenced earlier, and the 'fast food' on ... I > shall be in your debt eternally! (They are so fab, and perfect to > illustrate that a naked breast is... a naked breast. They are not > sexualised at all!)> > many thanks....> > Morgan> > ***********************************************> > Archives: http://community.lsoft.com/archives/LACTNET.html> To reach list owners: [log in to unmask]> Mail all list management commands to: [log in to unmask]> COMMANDS:> 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail> 2. To start it again: set lactnet mail> 3. To unsubscribe: unsubscribe lactnet> 4. To get a comprehensive list of rules and directions: get lactnet welcome> > > > ***********************************************> > Archives: http://community.lsoft.com/archives/LACTNET.html> To reach list owners: [log in to unmask]> Mail all list management commands to: [log in to unmask]> COMMANDS:> 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail> 2. To start it again: set lactnet mail> 3. To unsubscribe: unsubscribe lactnet> 4. To get a comprehensive list of rules and directions: get lactnet welcome> > ------------------------------> > Date: Fri, 16 May 2008 21:34:37 +0200> From: Marianne Vanderveen-Kolkena <[log in to unmask]>> Subject: Re: Supplementing the Hypoglycemic Newborn> > ----- Original Message ----- > From: "Cheney, Tanya" <[log in to unmask]>> To: <[log in to unmask]>> Sent: Friday, May 16, 2008 7:51 PM> Subject: [LACTNET] Supplementing the Hypoglycemic Newborn> > > **Hi Tanya,> > At this time, our director is not willing to allow nurses syringe or cup > feeding due to the risk of aspiration or perforation of the palate.> > **If you would use a silicone finger feeder on top of a syringe, I would > think the risk of perforation of the palate to be reduced to zero...> > When I suggested paced bottle-feeding with a slow-flow nipple, management > frowned because the baby needs to be fed quickly to get that sugar up.> > **Hmmm, pretty weird, right...? Do they also stand with a stopwatch next to > a baby that's breastfeeding, telling it to hurry up getting that colostrum > out, to make sure he raises his blood sugar...? :-s> > We are a busy hospital and do not have 24 hour-a-day LC coverage. Any > suggestions on how to please the parents who don't want bottles used while > treating their hypoglycemic newborn?> > **I would say, as may be concluded from the above: a finger feeder on a > syringe.> > Good luck!> > Kindly,> > Marianne Vanderveen, Netherlands> > ***********************************************> > Archives: http://community.lsoft.com/archives/LACTNET.html> To reach list owners: [log in to unmask]> Mail all list management commands to: [log in to unmask]> COMMANDS:> 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail> 2. To start it again: set lactnet mail> 3. To unsubscribe: unsubscribe lactnet> 4. To get a comprehensive list of rules and directions: get lactnet welcome> > ------------------------------> > Date: Fri, 16 May 2008 15:39:43 -0400> From: Sam Doak <[log in to unmask]>> Subject: Re: Supplementing the Hypoglycemic Newborn> > I would wonder if the "initial low blood sugar" is because the baby was> separated from the mother? > > Newborns have no ability to create heat. Many nurses like to grab up the> baby, dry it off, wrap it like a burrito and put it under a warmer. I liken> it to wrapping up a chicken off the counter, and putting it under a warmer.> In 1/2 hour, is the chicken going to have a raised core temp? No.> > If a baby is cold, he uses his blood sugar first, and then fat stores to> create heat, thus decreasing blood sugar levels and then fat stores.> > A cold baby is a hypoglycemic baby. > > My first intervention would be to get that baby on the mother's bare> belly/chest, wrap them up together, and let her hormonal heat source heat> that baby up to preserve blood glucose. If the mother is not available,> strip down the father or grandmother, get the baby on a naked chest, and> wrap them both together. The mother is the most effective baby warmer.> > If you're seeing a lot of initial hypoglycemia, perhaps the birth sequence> needs to be evaluated. Instead of treating the symptoms, fix the cause.> > Sam Doak> > <<> > I want to find out what other hospitals are doing about initial low blood> sugars on newborns when parents do not want bottles used. > > There is no expressed colostrum because the mother just delivered (yes, I> know some may recommend that she pump at 38-40 weeks prenatally if her baby> is at risk for hypoglycemia, but our docs won't go there). At this time,> our director is not willing to allow nurses syringe or cup feeding due to> the risk of aspiration or perforation of the palate. We have many new> nurses who have not been trained or are comfortable doing this anyway. When> I suggested paced bottle-feeding with a slow-flow nipple, management frowned> because the baby needs to be fed quickly to get that sugar up. We are a> busy hospital and do not have 24 hour-a-day LC coverage. Any suggestions on> how to please the parents who don't want bottles used while treating their> hypoglycemic newborn?> > > > > > Tanya E. Cheney, RN, BSN, CCE> > Lactation Consultant> > Hampton Roads Area of Virginia> Taking IBCLC exam in July> > ***********************************************> > Archives: http://community.lsoft.com/archives/LACTNET.html> To reach list owners: [log in to unmask]> Mail all list management commands to: [log in to unmask]> COMMANDS:> 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail> 2. To start it again: set lactnet mail> 3. To unsubscribe: unsubscribe lactnet> 4. To get a comprehensive list of rules and directions: get lactnet welcome> > ------------------------------> > Date: Fri, 16 May 2008 12:37:52 -0700> From: Lyla Wolfenstein <[log in to unmask]>> Subject: cross post - baby who cannot/won't latch well with shield, nipple compression with "perfect" latch> > greetings, i seem to be challenged with the complex pain cases lately. => here is our latest:> > now 2 month old baby, saw us when baby was very new, and has seen us 3-4 => times since. at first, baby VERY "tight" in the gums - born by => c-section, full tongue mobility, no posterior or submucousal tongue tie, => normal palate. mom came for pain - no damage, but significant => compression after unlatching. i was able to help mom get pain level 0, => but there was still some compression, and mom wasn't able to duplicate => painfree latch at home. when she came back in, i was unable to get it => lower than a 4. after many weeks of struggling, 3 cst visits => (significant release from the CST, but chiro says now nothing more to => do, but says still "tight" in one side of hte neck and to rub it and => help stretch it..) and finally, a week resting the nipples and pumping => and bottle feeding (using appropriate bottle technique and nipple), she => was pain free after the week of healing (derm had prescribed cortizone => and she's been using APNO too) - she restarted nursing and it was pain => free for the first few feedings *during* feeding - but significant => compression and burning after. =20> > mom came in today, having just been resting the nipples again for a few => days, and pumping - we latched the baby on - *perfect assymetric latch* => - wide angle at junction of lips, chin buried in breast, nose tilted => slightly away, nipple tipped up toward nose (and aligned with nose => before latch) - perfect. pretty comfortable nursing too - BUT => tremendous compression along the horizontal plane (striped the same way => as the lips were angled.) she was confident that if she nursed like => that a few times, the nursing would be painful soon, based on => experience. nipples look pink-ish and inflamed, but there are really no => yeast/vasospasm symptoms, other than the pain - and given the tremendous => compression it seems like looking for zebras when the horse is right => there.... inlike my client with NO compression but significant pain.> > we tried a shield - and baby latched initially - sort of - baby really => wouldn't open wide for the shield and didn't seem to like the feel in => the mouth, and seemed frustrated with the flow rate with the shield on. => the smaller shield worked a little better, actually than the large one, => but baby still had a "clampy" latch and came on and off and then refused => to nurse really with it there. bare breast immediately comforted baby, => and baby nursed well again (but compressed nipple). milk transfer is => excellent - no sign of OALD - tranferred 42 cc on the first breast in => about 5 minutes or so, baby managed flow well, etc. =20> > so my primary questions are:> > - why would a baby do so poorly with a shield? mom found it much more => comfortable, and as much as i don't like using shields for pain, we all => thought this might b e a good temporary solution...> - would a different CST practitioner by possibly able to go "further" => with the "release" and get things more comfortable?> - would a different body work modality work better for such a baby - a => textbook latch but something *invisible* going on in baby's mouth after => latching (sucking on my finger didn't bring out any glaring => challenges...but who could do a more involved suck assessment....?> - what about an SLP? i have a call into one - are there specific => treatments/assessments i should ask about to assess her skill with => breastfeeding issues?> - any other ideas for suck training, tongue training or what else could => be causing this compression? baby led latch yielded no better result, => and mom is NOT touching baby's head or making any of the common => mistakes. =20> > thanks!> > Lyla> =20> > > Lyla Wolfenstein, B.S., IBCLC, RLC> Owner, Lactation Consultant, Parent Educator> > =20> > Zenana Spa & Wellness Center, LLC and Beyond Birth Lactation Services> 503.238.mama (6262) or 504.232.baby (2229)> mobile 503.754.2718 fax 503.473-8047=20> email [log in to unmask]> web www.BeyondBirthServices.com and www.Zenana-Spa.com> > ***********************************************> > Archives: http://community.lsoft.com/archives/LACTNET.html> To reach list owners: [log in to unmask]> Mail all list management commands to: [log in to unmask]> COMMANDS:> 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail> 2. To start it again: set lactnet mail> 3. To unsubscribe: unsubscribe lactnet> 4. To get a comprehensive list of rules and directions: get lactnet welcome> > ------------------------------> > End of LACTNET Digest - 16 May 2008 - Special issue (#2008-592)> ***************************************************************>
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