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Subject:
From:
Kathy Bowers <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sun, 8 Sep 2002 21:48:55 -0400
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Dear Friends,
In the light of the ongoing discussions regarding delayed lactogenesis and it's numerous and varied causes, I decided to share a recurrent nightmare with you. 
A mom at 36 weeks gestation with pregnancy induced hypertension is admitted for a cervadil induction with labor augmented with pitocin. She is placed on MgSO4 and IV antibiotics. She is given morphine so she can sleep through the night. After she wakens, she finds herself in labor and therefore diet restricted to clear liquid. She still holds onto the hope to "go natural" so she declines an epidural and opts for Stadol. After 2 doses, she decides to have an epidural. Her labor progresses rapidly, but now the baby's heart tones are showing signs of distress. After a failed vacumm extraction, baby is delivered by emergency c/section. Baby is slow to respond to stimulation,undergoes vigorous and repeated suctioning and then is whisked off to the nursery. Baby is placed on a radiant warmer, has a cephalohematoma,is stressed, cold and has a low blood glucose according to a heel stick. A phlebotomy is performed for a blood culture and CBC. An IV is started to deliver D10W and antibiotics. 
The next day, mom attempts to breastfeed, but the baby is not able to latch on, so baby is cupfed formula. Late in the day, baby is looking jaundiced, so another lab draw is performed. Baby has +coombs and early jaundice is placed in double phototherapy. Somebody thinks it is time to contact the lactation consultant. Then I wake up wondering where to start. Unfortunately, many parts of this nightmare are drawn from "just another day at the office."
Kathy Bowers, RN, IBCLC taking time out from preparing for a conference in 9 days. 

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