Dear All:
to those of you that answered ny earlier post on weight gain - thank you.
You all pretty well confirmed what I had thought but some peds are
recommending 1 - 2 oz/day (29g - 58g) and I just wanted to check.
The main reason I asked this question was because I have been consulting with
a client for the last month. She delivered by VD on 9/9/99 an 8#7oz girl. I
first saw her 4 days later. Alert infant, slightly disorganized suck on suck
assessment but sucked well after only a couple of minutes of training. Mom
had sore nipples. Really only worked on placement and positioning and baby
lateched beautifully and fed well! Momtook baby to clinic next morning they
DID NOT weigh her but said she looked fine. I saw her the next afternoon and
things were going well. Originally I had been prepared to do bells and
whistles (i.e. cup, SNS, shield, whatever) but with just a little correction
the baby did well. She saw MD a couple of days later (My notes are packed
since we just moved so forgive me on details) and the weight was 7#11 oz, 3
days later it was
7#14oz... I spoke to this mom via phone almost daily. Mostly just
encouragement. Voids and stools were fine. Encouraged demand feeding. This
baby's pattern seemed to be lots of small cluster feedings in am, then every
3 hours in afternoon-evening, and she liked to sleep at night. Mom would try
to wake baby every 3-4 hours but oftimes she was disinterested. I told the
mom I felt that with the lengthy am feeding times, and her wanting to sleep
at night that I felt it was ok and encouraged her to go 4-6 hours. This
clients sister is a LLLL and has also been giving advice. 9 days later the
baby had gained 6 ozs. The ped said this waas acceptable but he would have
preferred 9 oz...
In the meantime the patient would call with questions re: plugged ducts,
blebs, feeding times etc. The baby was always voiding/stooling well, feeding
alot in morning, avg space daytime, sleepy at night...She called me last
Saturday and told me how "hard" this has been. She has a history of
Psoriasis and allergies and is very committed. I have found her to be(and
she is self-professed)very 'anal', controlling, ex-corporate woman and
encouraged her to enjoy her baby and let the baby direct feeding instead of
working at waking her at times when she doesn't want to feed. I also
suggested that If for 24hours we watched what the babies natural pattern was
then and only then could we determine if there was cause for concern. She
had also been doing alot of "taking baby off and changing breasts every 5
minutes", at her sisters suggestion, to keep baby "interested". I suggested
that if she was going to do this that she should return to same breast to
ensure ingestion of the hindmilk
Well on Monday the babies weight had dropped 1 oz in last 12 days!!!
Needless to say we were very surprised!!! At this stage of the game I told I
would need to see her and that we needed to initiate a SNS while we assessed
the situation (infant suck, milk supply etc). I told her to get
Fennucreek/Blessed thistle (mom states her breasts have felt different in
last week and ped wanted her to increase her supplY!) and to pump either
manually, or hand pump or mini-electric or whatever for 5 minutes before
feeding and then latech on to ensure incresed hind milk ingestion (I have a
feeling she has been getting predominantly foremilk). We made an appointment
for that evening.
She called me back and said her sister had told her that an SNS would alter
the babies suck pattern and did I think it would be a good idea to go to a
well known lactation education center here in So. CA that is 65miles north of
us. I told her that while they were great that I did not think that was
necessary, that I would like to see her first.
I called her before going to see her and she told me that she had made an
appointment at the lactation center for NEXT Monday. She was going to
supplement in the meantime. She was very grateful to me but felt she needed
to try something "different". They told her to pump with a Medela pump, and
that 'they use' the syringe feeding method. I gently discussed with her that
there are a variet y of methods and that the important thing is to ideally
compliment at the breast, and then go to finger feeding or cup feeding. I
suggested that bottling the baby for one week may in fact diminish her
chances of success. Shesaid her sister was going to see if they could see
her sooner because 'She knows the director". She is continuing with the
herbs, and will start double pumping. Itold her to call me if she changed
her mind, and that I supported her choice to get a second opinion but that a
week was a long time, and some intervention with me would be better than no
intervention. I also feel that up until now there were no real indicators to
do anything different and that now that there is that I did not get an
opportunity to try what I know...
I told her I would post her case to you all for suggestions, ideas, thoughts
etc.
I realize that I am taking this slightly personally...and this is on the
heels of getting flak at work for encouraging demand feeding, for saying
things like "its normal to nurse every 1-3 hours in the first few days, etc
etc. Not to mention that I am still nursing my 23 month old!!!
Thank you for your support...
Liz Benbrook, IBCLC
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