I will take a stab at this, although you probablyhave considered most of
what I can think of already. Here goes--The good news is that 11 days is a
relatively short period of time, in spite of knowing that a poor start is
not a good prognosis. However, I have recently had luck with moms whose
babies had not latched for 8 and 9 weeks and are now breastfeeding! One
needed a nipple shield, and the other used cranial sacral therapy on baby in
addition to the usual lactation tricks. See Dr. Newman's book re breast
refusal and time frames--sometimes persistence does pay off. So, I would
give the mom the perspective that it is still early, and much can change and
be tried in the meantime.
What kind of pump is she using? I am often surprised when I ask and find
out that the pump is one that I know does not work. Sometimes she is using
a "good" pump, but may need observation and lessons on technique, time, etc.
Her age, any fertility issues, endocrine issues (have her get thyroid
function checked and other routine bloodwork) are also things I look for
with milk supply problems that should be remedied by frequent and thorough
emptying but are not.
Have a speech pathologist or occupational therapist referral for
suck/swallow evaluation. They often know mouth stuff that we don't.
LLLI Answer Book on Breast Refusal and how to get baby to breast (many
stages and steps) is excellent.
If mom is at end of rope at 11 days, she needs to relax a bit and realize
that although this is extremely frustrating of course, she is only just
beginning --as long as the baby is getting fed and she is working on her
milk supply, she is buying herself time and sometimes that is the real
answer. Try to get her to focus a little bit more on having a baby to love!
I don't mean to sound Pollyanna, but we are all guilty of trying to push too
hard sometimes. I realize that this is not really normal, but it MAY
improve, and taking some pressure off really can help.
Dr. Newman is a great resource by [log in to unmask] I believe.
I do not encourage false hope, but until there is still one more rock to
turn over, I keep on looking and trying, as long as the client is willing.
I let them know that I will support their decisions all along the way and
encourage mom to follow her own heart to know what is best.
Insufficient glandular tissue is always a possibility, but I don't honestly
know how to evaluate except by exhausting all other measures.
If baby will latch, an SNS will provide milk and stimulation, AND the effect
of breastfeeding.
Nubain will result in no suck postpartum, although not supposed to be
permanent.
When you said uneventful labor and no other medical issues, I assume that
you have gone into detail with her--amazing what I uncover when I dig deeper
sometimes.
The odds are with her, and so is time. Easy for me to say, I always tell
them. However, it is often true.
Lots of luck to both of you. P.S. I also tell them that I wouldn't be
doing this work if every mom could BF without any difficulty--another big
picture thought that I hope makes them feel less unique and have some hope.
Yours truly,
Patricia Ellis
Bridgewater, NJ
[log in to unmask]
----- Original Message -----
From: "Dawn Lanser" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, June 08, 2001 10:25 PM
Subject: Delayed Milk
> I have a problem with a mom that has given me permission to address all of
> you smart people. I have a prime mom and an 11 day old baby. I was
called
> in today. She has been working with the hospital and her dr. Since she
> still cannot get the baby to the breast and does not pump more than 1/2
> ounce, she called me. Baby was 2 weeks early. Uneventful labor. Mom had
> epidural for approximately 5 hours and a little nubain. Baby would not
latch
> on. Hospital gave her pump and began to cup feed. Five days ago, her dr.
> started her on Reglan 10 mg qid. Baby is also getting a bottle now. She
is
> now sore and small amounts of blood. Using lanolin. I have not seen her
and
> have only done a phone consultation. She was unavailable today. I
suggested
> going to bed with baby with skin to skin contact. Offering her breast
often.
> Pump if baby not taking breast. Suggested possible use of SNS. She
hopes
> the Reglan will kick in. On day 3 she did have a fullness in her breast,
but
> never able to latch baby on or pump very much. I suggested she might
start
> taking herbs also. This mom is at the end of her rope. I really can't
blame
> her. It is after midnight after a double header at the baseball field.
> Please excuse me if I leave something out. I would appreciate any
assistance
> at all. I know I need to get the baby to breast, but what about her
lacking
> supply. Mom stated she has no health problems and is not taking any
> medications. That is all the information I have. Thanks for listening.
>
> Warmly, Dawn Lanser, RN, BSN, LCCE, IBCLC
> South Bend, IN
>
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