Dear Lactnetter,

Thanks for all the response, private and otherwise, on this issue.  So many
good suggestions and thoughts.  An update:

1)  OB/GYN evaluated and felt that there was no retained placental tissue
although he did nothing beyond a regular vaginal exam.  He did order blood
work to check thyroid function, iron levels, etc.

2)  Talked with the pediatrician who was glad baby was gaining and hadn't
noticed a problem with low tone but did not question my evaluation.  She was
of the thought that as long as baby was gaining she was happy.  Didn't think
there would be a low grade infection w/o other symptoms and said the only
really accurate way to check for urinary tract infection was with
catherization.  Too invasive for mother's feelings and mine at this point.

3)  Mother is completely overwhelmed.  She hates pumping, felt that her baby
was no longer hers, that she didn't even know normal cueing any more, etc.
I laid out all her options from bottle feeding all the way to complete
pumping, supplementing, etc.  I explained SNS use vs P-syringe use, etc.
Everything I could think of.  She opted to stop pumping for a few days and
just follow her babies lead.  I went into detail about normal output,
dehydration, etc.  Told her to watch the baby and supported her need to
reclaim her baby (felt bad that she felt this at all).  Day 1, baby did
well, mother felt suck was better, mother felt fullness for the second time,
ever.  Day 2, mother called at the end of the day crying.  Baby had been
feeding constantly all day, poor suck again, no stooling, very unhappy baby.
Mother supplemented 2 ounces with p-syringe and her breasts felt completely
soft.
        At least now mother knows baby will cue her if hungry and respond in
the appropriate manner.  Baby doesn't seem able to maintain the milk supply.

        I am aware that with this type of bubble (and it is deeper and more
pronounced than any I've ever seen) baby may not be able to form enough of a
seal to maintain suction.Correcting positioning, etc, doesn't seem to make
enough difference.

        I think there is some low tone with the baby that needs to be
addressed.  I think mother needs to come to terms with the fact that this
isn't going to be an easy fix.  Mother needs to evaluate what she can do and
what she cannot do.  How far she wants to go with this is entirely up to
her.  She desperately wants everything to be easier and smoother (like it is
for her friends).  She doesn't have much energy and becomes exhausted and
overwhelmed easily.  She can't manage pumping and breastfeeding without help
in the house at all times.  That issue alone is wearing on her.



Denise Parker, BA, IBCLC (La Crescenta, CA)
To Avoid Criticism, say nothing, do nothing, be nothing