Hello!
My name is Lanell Coultas, and I'm a birth and postpartum doula in Austin,
TX.
I am currently working with a client that delivered prematurely at 32 weeks
(as a result of a complication with polyhydramnios-baby has now been
diagnosed with Treacher-Collins Syndrome which affects cranio-facial
development, he has a cleft palate, recessed chin, no outer ear formation,
and slits in the lower eyelid). Baby is now 2.6 weeks old and will be in
the NICU at least until early May (her EDD). Hours after delivery I got a
hospital LC in to see her and she immediately started pumping with a
hospital-grade pump (Medela, I believe). The hosp LC has her on a stringent
pumping schedule (every 2-3 hours) which she's been following to a "T". Her
supply has been great, baby is just now taking about 40 cc at a time thru
his feeding tube. Yesterday they started supplementing baby with some kind
of extra nutrients (client says it's in a powder form that they mix with her
BM). Since the first feed with the extra nutrients, baby has been throwing
up. So, now they've scaled back on the nutrients and are going to start
adding them slowly in. My client went to see him this afternoon on her
lunch break and says he looks very pasty (lack of color) and she just feels
in her gut that this extra nutrient stuff is not good for him.
First question: Are these nutrients really necessary if baby is gaining as
he should? He started at 3 # 5 oz @ birth and is now up to 4 # 7 oz (2.6
weeks later). Am I mislead in thinking that my client is making the exact
kind of milk that her preemie baby can digest and utilize effectively to put
on weight? It seems to me that her body knows she's delivered early, and
these signals create a different kind of milk than that of a full-term
baby/mother pair. Am I totally off-base here?
Second question: My client has developed (rather suddenly, overnight)
localized swelling in her wrists, knees, and ankles. She was bending down
to put her pump in her car and when she got back up she remarked, "wow, my
knees are achey" - as the day has worn on, she's also noticed her legs feel
weak and "noodley". She went to see her OB and the nurse pract talked to
her about breast infections that could show flu-like symptoms. She says her
breasts look and feel normal, not hot to the touch, no redness or streaking,
or localized pain in either one. Her supply is still good, no major
increase or decrease since the swelling occurred. Could this swelling be
related to a breast infection? I also quizzed her about foods she's eaten
in the past 48 hours that might be causing this swelling/achiness. She said
she hasn't had anything different than usual.
Of course, my first item of business is to recommend she see an LC in
private practice, but does any of this seem like a red flag?
Thanks in advance!
Lanell
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Lanell Coultas - CD (DONA)
Birth & Post Partum Doula Care
Austin, TX
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"Ask the woman; she will tell you everything you need to know."
-Ina May Gaskin
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