This is a lengthy post but I would appreciate any help or information.
Saw mom and baby Wednesday, natural birth at a freestanding birth center on
Sunday, but with long pushing stage (4 hours) that ended in separation of
the ligament connecting to the pubic bone (so poor mom can't walk; she is
taking percoset). Birth weight 9 lbs. 7 oz. Baby first fed about 8 hours
after birth (despite going right to breast after, and trying several other
times). Baby then fed on and off as family returned home, sometimes
comfortable, more often painful. Baby had many wet and stool diapers, and by
Tuesday had a transitional (green) stool. On Tuesday at pediatrician baby's
weight was 8 lbs. 10 oz. No stool in last 24 hours (but many wets),
Wednesday weight at ped was 8 lbs. 5 oz. (12% weight loss). At the
consultation mother positioned baby well, he latched with fairly wide gape,
mother reported some pain, no compression on one breast and slight
compression with blisters on nipple tip on other breast. Total transfer for
feed was 8 ml, baby clearly hungry and fussy after. Baby is yellow, had bili
test today and ped called while I was there to say they didn't get enough
blood so poor dad had to take baby back to hospital to get blood drawn
again. Suck assessment seemed pretty normal, baby was too fussy to get an
evaluation of tongue extension or lateralization, didn't see too much
elevation.
Mother reports some breast changes in pregnancy, no significant hx except
saw reproductive endocrinologist after not being able to get pregnant
(eventually took a year), blood tests revealed "somewhat high testosterone
levels, consistent with possible PCOS" although she said PCOS was not
actually diagnosed and she was not treated for it. She did see an
acupuncturist to assist in becoming pregnant. She doesn't have any obvious
(to me) physical signs of PCOS. Her breasts are rounded and full, on the
smaller side but normal, somewhat wide spacing but not unusual looking.
She was able to hand express a drop of colostrum after feeding, but later
was not able to express any more. She has tried using her Harmony hand pump
and hasn't gotten anything. Yesterday (day 2) she felt some increased
heaviness in breasts, nothing further today.
Questions:
If milk production is a problem, why would they have seen a transitional
stool? (They have a copy of the diaper diary and identified it as the green
stool on that page)
Could the elevated testosterone levels pre-pregnancy be a result of an
ovarian theca-lutein cyst, or do those only happen postpartum?
What blood tests might I suggest she ask for? I would ask for prolactin,
thyroid panel, testosterone, maybe HCG (lochia sounds normal); is there more
she should ask for to help evaluate possibility of PCOS playing a part?
I encouraged parents to feed baby some formula when mom was not able to
express more colostrum (they are probably one of very few parents with NO
formula in the house). I taught finger feeding (as best I could with nothing
to feed) and provided curved-tip syringes. I encouraged mom to continue hand
expressing and/or using her Harmony pump for now, then renting a pump if no
increase in milk evident in another day or so, and to consider
galactagogues. Continue putting baby to breast. Have baby evaluated by
chiropractor (fine with parents).
These parents are lovely and really want to breastfeed.
Lisa Mandell, MBA, IBCLC
Havertown, PA
www.best4both.com
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