Hi all,
I had a tough case yesterday - a mom of twins born at 32 weeks, now
adjusted age 5 days. Babies in NICU for 2 weeks with only 2x/day contact
w mom. Most mom ever pumped (pumping 8x/day) was 6oz in the whole day.
Babies now refusing breast (have only ever fed with shield), mom pumping
4-6x/day w total output 3-5oz/day. I asked her what her goals were, and
she said she'd like the 3am feeding to be at the breast, not having to
get up and deal with bottles in the middle of the night. Currently
babies are getting 80ccs formula every 3-4 hours. Mom moved to the area
2 weeks ago, husband travels 4 days/week for work, her mom is here
helping, but she just doesn't have enough help or support. Ideal plan
would be to get babies to breast with SNS, mom pumping more, doing
skin-to-skin - but she's overwhelmed. Worked with one baby yesterday to
feed at breast, had some success with feeding tube under nipple shield -
but feed was very slow and leaky.
Mom is going to try this week to do one or two feedings per day per baby
at breast with tube, keep pumping, and do the remaining feeds with
bottles. I see her again in one week.
Honestly, I feel like with her current resources, any more than this is
too much to ask. Her postpartum care did not support breastfeeding
adequately, she never has established a milk supply. I'm not sure how to
tell her that her goal is not achievable with her current efforts and
resources. She is already on Reglan as well. She just never got the
right information about what it would take to make breastfeeding these
babies realistic and has been limping along for 8 weeks.
I don't need info on treatment plans for her, these I can figure out.
But any ideas about how to have a frank discussion with her about the
likelihood of any real breastfeeding with these babies would be
appreciated.
The goal for right now is to get the babies a few positive experiences
at the breast with the feeding tube, and go from there.
Thanks,
Kirsten Berggren, PhD, RN, IBCLC
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