These two cases might be interesting to some of you lactnuts out there.
1st case:
We had a mom deliver at 34 weeks in the middle of what she thought was a
'summer cold.' Turns out she had pneumonia and developed adult RDS;, ended
up in adult ICU, sedated, on a ventilator and Pavulon (which, for those of
you who don't know, paralyzes the person temporarily so they don't fight the
ventilator) Mom was completely paralyzed and only partially conscious. The
baby, meanwhile, was in much the same condition in NICU, but minus the
Pavulon. Both sick, sick, sick.
Believe it or not, after the husband told the nurses in adult ICU that the
mother had really wanted badly to breastfeed, they got a pump from CD at
1:00 in the morning, and pumped her breasts FOR HER every three hours all
night long. ......
That has to be a first! They got grandma and dad to do it during the day.
I didn't have to go down, tell them how or what to do, or anything. I heard
about it much later. WOW!
The only problem I had was that, because of the medications the mom was on,
they dumped all the colostrum down the sink. After checking the safety of
all the meds the mother was on, and telling them that it was okay, they
said, "Well, we have an order to pump and dump anyway." NOOOOOO!!!!
I finally convinced them not to throw it away, to send it right on up to
NICU and we would use it for the baby. By today, the baby had yanked out
her own endotracheal tube and gone to room air.
This evening, mom is awake, off the sedation and Pavulon, doing her own
pumping and looking forward to nursing her baby sometime in the next few
days. Hopefully all will go well so that tomorrow, we can take the baby to
adult ICU for snuggling and breastfeeding.
2nd case:
The other case is a mom who called today with a fairly complex problem. She
had premature (34 week) twins who are now 5 1/2 weeks old. I saw her in the
hospital a number of times and we got the babies both nursing well, but
because of low tone and fatigue, they were not able to totally breastfeed
and still gain weight. So, we were gavaging three feeds a day to allow them
to sleep through some feedings. Then somebody told her that she needed to
get the babies on a bottle so we could get them home sooner, which she did,
and now has two babies who have never ever gone back to breast with all
kinds of coaxing methods suggested by a LLL leader. She is pumping and
bottle feeding twins and is exhausted.
To compound the problem, the mom had a lumpectomy 14 mos ago (one day before
her wedding for heaven's sakes) and that breast is painfully and
chronically engorged. No amount of warmth, massage, nipple stim, pumping,
hand expression, oxytocin spray has helped at all. She simply cannot get
milk out of that breast. Most of the time she gets 2 - 30 cc out , although
about every three days, she says it is like the whole thing explodes and she
can get six ounces out all at once. Then she feels pretty good for a couple
of days until the pressure builds back up. (Would scar tissue or strictures
explain this, or what? Anybody know?)
I suggested wearing hard shells thinking the "leaking faucet" principle
might reduce some of the tension within the breast. Looked it up in Riordan
and Auerbach, checked with several other IBCLC's and didn't come up with
anything really helpful. Mom may be able to completely allow that breast to
involute and produce enough on one side to supply twins, but she is nervous
about it. She is going to come in and we will help her get the babies back
to breast, but I sure wish we had two of them functioning. Maybe the babies
will have better luck than the pump. If anybody has any suggestions, I
would love tohear them.
Deanne, R.N. IBCLC
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