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Subject:
From:
"Mary Jozwiak BS, IBCLC, RLC" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Thu, 3 Apr 2008 12:13:50 -0400
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Thank you all for your input. I think this case is really more complicated than 
just "inadequate intake." Not all of us can know everyone else on Lacnet, I've 
been helping women breastfeed for 20 years, and been an IBCLC for nearly 15 
years. I have worked with thousands of mother-baby dyads of all ages and 
issues.  I *know* something else besides (and most likely in addition to) a 
little "underfeeding" is going on here. 

As I am the Mom's friend, I think it may be best if I refer her to someone who 
maybe isn't as emotionally close to her. She knows I have a pump here, if she 
needs to rent it (made it clear that pumping might help her supply) ect. 

I have felt her ducts working while this baby nurses, I have changed this 
child's copious diapers, fully wet, and heavy with stool. I have also seen him 
drift when the Ejection is over, and then start again when it begins, he is not 
a lethargic baby, and I KNOW this may be related to the problems. 

He also has a bit of a receded chin, which I hoped would have grown a bit 
now, but has not. He can, however, properly latch asymetrically, a good deal 
of the time. 

He has, however, grown in length and head circumference. Why is he only 
interested when she is ejecting? I have seen him satiated after a good 
nursing, if he isn't full, he lets her know. This is NOT garden 
variety "insufficient intake" as I have seen that 1000 times before, and this is 
different. 

She is starting on Fenugreek, is at the Chiropractor as I write (for herself and 
the Baby to get an other adjustment) and I can still be here to help her. (She 
lives less than 100 ft from me, I can't help but be here.) 

If necessary, she said she will give the baby her pumped milk in a syringe or 
SNS. (She is Dead Set against any bottle use, and I agree, there are better 
ways to get milk into a baby.) My guess is, she will, despite my urging to do so 
sooner, wait until she sees his Ped next week, who I am guessing will freak 
out, and focus SOLELY on the weight and nothing else. 

I am sure other things are going on, which is why I posted. I can identify and 
deal with supply and inadequate intake issues, I know how to weigh babies, 
(thank you all for your advice anyway, I am sure some new budding LC will get 
good use out of the information.)  I need some "outside the box" ideas on 
what this could be. I hope she will take the pumping advice and also make 
sure the MD does a complete exam of the baby next week, and doesn't JUST 
focus on the weight. 

I just have one question. She had no drugs during the labor or birth. Could the 
meconium staining have anything to do with a large water retention? I know 
pitocin can, as can IVs and other drugs given in labor, she had none of these, 
however. It is possible that this baby was never meant to weigh 9 lb 1 oz at 
birth. I don't know. 

Thank you all for your help. 

Mary Jozwiak IBCLC, RLC, LLLL
Private Practice 

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