Hi Tricia,
Thanks for the additional info on this 34 wk infant and mom. I think anyone
working in nicu would expect that such an infant would lose weight in those
first few days (they do not begin to gain until they are completely off IV
and onto full milk feeds), so I am feeling it was not necessary to reduce
the breastfeedings due to wt loss. I believe that was a "blame the bf"
moment. One does have to assess how baby is doing at breast, and what baby
is doing. An hour of "feeding" could mean the baby is struggling for an hour
and only getting 3 mls, or this hour could have been skin to skin and baby
licking or sucking a little and having a very good experience. Personally, I
am very much in favor of gavage feeding (small tube from mouth to stomach)
for babies not feeding well, but some nicus really 'force feed' the baby by
nipple, IMO, feeling this is such a better way to feed. I guess this is not
relevant to your situation, but it irks me that baby cannot be let to
leisurely bf and then get his expressed milk by tube if needed, while STS
with mom.
Back to your case, I would focus on everything positive. Continue reassuring
mom and letting her know that things will improve as baby grows and
developmentally matures. With PCOS, I typically see very soft or flaccid
breasts, so I am not thinking dense tissue is her problem. I would just
reinforce the basic stuff: STS, bf as baby is able, regular, frequent
expressing with massage, hand, and electric pump. See what family and
friends are doing and can do to help make mom's life easier; are they
cooking for her, can she stay nearer the baby, etc?
Laurie
Laurie Wheeler MN RN IBCLC
Mississippi USA
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