Hello all,
This is my first time posting having only recently upgraded my PC to allow
me these facilities (and now I am lactnutter too!). I work with Jean Ridler
in Cape Town, South Africa and have just re-written *the exam* after 10
years. I have been working with a mom for the past week and would welcome
any help from the collective brainpower. I first saw this baby at age 3
weeks. The mom was desperate to breastfeed but had been advised by a baby
clinc to supplement the baby with ABM (in a bottle) as the baby was not
gaining weight.
The mom arrived at hospital about ½ hr before the birth - no time for drugs
or interventions. Breastfeeding was initiated but the baby did not do well
and a stomach washout was done. Bf did not improve. Birth weight was 3,650
kg and lowest weight 3,180 kg (a loss of 12.9%). Weight at my first visit
was 3,536 kg (after a feed) and baby had been receiving 50-75ml ABM ± 3
hourly after attempting to first breastfeed. A nipple shield had been used
on one breast and baby refused the other breast completely. During my visit
we managed to latch the baby fairly easily to the one breast without using
the nipple shield, with a minor episode of suck/swallow and the occasional
swallow. The mom's milk was dripping from both breasts during this time. For
most of the time spent at the breast the baby "munched" (jaw action and
nothing else). I introduced feeding ABM at the breast with a no.5 Naso
Gastric tube and the baby sucked and swallowed regularly until the end of
the feed. ± 10ml of breastmilk was "caught" from the other breast. The baby
will now feed from both breasts but continues to "munch" unless the NG tube
is there. Mother is now pumping 50 - 60 ml EBM after every feed
and has tried co-bathing and skin-to-skin contact. Baby has gained 147g in
the week. Are there any other buttons we can push or do we just need a
"tincture of time"?
Thank you for your help.

Rose Gauld, RN, RM, IBCLC
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