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I have permission from my client to post this and share her story with other professionals., so we can learn from her story and help other mothers.  
LF  was diagnosed having multiple cysts in her ovaries during her adolescence.  She also has had persistent acne.  LF delivered by Cesarean Birth (epidural) a healthy baby boy,  June 13, 2004.  Paolo:  BW 3,650, length 52 cm, apgar 9/9.  Because of her higher risk profile, I chose to follow LF very closely for the first week.
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LF had her husband, plus myself as an extra support person. I am a strong advocate of the BFHI project and breastfeeding, so I tried to apply the 10 steps as much as I could without interfering with the hospital procedures. It was very difficult to apply  step 4, but one hour and forty-five minutes later, LF was able to hold Paolo skin to skin and breastfed  successfully!  I asked the staff to wait on the bath, and they were happy to do so.  Paolo was not bathed until the next day.

Breastfeeding History: I had LF start with a combination of breastfeeding and spoon feeding expressed colostrum by hand , done by me at first, then by  LF'a and husband . 

Day 1: 
6 breastfeeds plus a total of 24 ml colostrum expressed by hand and spoon fed 

During this period Paolo had 2 very large BM (meconium), and 3 voids.


Day 2:
Total:
 10x/24 of breastfeengs
1 large BM (meconium) and 3 voids


Day 3:  
Total:
8x/24
5 BM  and 3 voids

Day 4:
Total:
11x/24
6 BM, transitional stool  and 4 voids


Day 5:   During the night it went as usual.  But since this was the  last day at the hospital, the routine breastfeeding schedule was interrupted.  The staff told LF, not to breastfeed for 4  hours the next morning Paolo had to beon an empty stomach for the PKU test (please, do not ask where where the evidence is for this request!). Paolo was screaming and rooting all morning!  You can imagine!

Day 6:  the breast felt soft (even in the a.m.), and Paolo felt asleep at the breast. 
Day 7:  I immediately had LF start  pumping, 10min after each breastfeeding.  The first day she collected 30ml after each pump.  
Day 8: 50ml, and sometime 20-30ml in the evening.  
Paolo only had scant green BMs but lots of voids!  And very sleep at the breast.  I did compression, no audible swallowing.    I started to get worried.  
Day 9:  I gave Paolo 40ml of breastmilk by tubing (jack newman and rosellina way, breastfeeding with tube and 40ml in a syringe).
He perked up!  
Day 10: breasts were full again, and audible swallowing with increased BMs.

LF continued to pump her breast for 10 mn, after each breastfeedings until one morning when she called and told me she had collected 100ml of breastmilk at one time!  I told her to gradually stop, and pump every other feeding only for 10min.

Today, 16 days postpartum, her breasts feel full in the mornings, baby is breastfeeding 10x in 24hour, and 6+yellow BMs and lots of voids. Mom is doing well.  Baby has gained 200grams and is now 3,850. Paolo is 200 grams over birthweight on day 16'.   I told her about growth spurts, and  that if her breasts do not feel full and she does not hear Paolo swallow (she is very good in distinguishing between nutritive sucking and non nutritive sucking), to call me!  

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ciao,
Rosellina Cosentino


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