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Subject:
From:
Pamela Morrison <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Tue, 7 Jul 2015 11:25:20 +0100
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Hi Jacquie

Oh wow!  Sorry I just saw your message from yesterday.

Yes, I do think you need to be concerned, but probably for the baby 
more than the mother.  I would think it's almost impossible for a 
milk supply which had been so low that the baby was taking 560-840ml 
of formula a day, to recover in 24 hours. You're quite right that 
that quantity could comprise almost the baby's entire needs 
(180ml/kg/day), which means that the milk supply would probably be 
about 100-200ml per day.  I love low-gain cases, but even with the 
best of intentions I've never seen such a recovery happen.  The info 
I have is that - at best (and that's rare IME) a milk supply might 
double in 4 days with round-the-clock drainage ever 2 hours or 
so.  Also, when dropping supplements, the recommendation is not to 
reduce the amount offered by more than 30ml PER DAY, watch the baby's 
urine/stool output and then if  all is well _and_ the baby is 
starting to refuse, then the mother can reduce again.

Milk synthesis is governed by lactose.... so you're also right to be 
concerned about the mother's blood sugars.

But actually, I wonder if she might be spinning you a line to get you 
off her back sort of thing.... not implying at all that you've 
applied pressure, but I think that this is what some mothers do when 
they want to end the LC contact.

Hmmm, are you writing a doctor's report?  I probably would, outlining 
the history, what I observed, and what I recommended, both at the 
initial and follow-up consults, and send a copy to the mother.  Be 
sure to offer in there somewhere your concern about too-fast 
elimination of supplements and your recommendation for further 
follow-up with gradually reducing supplements to maintain the baby's 
health/nutrition, as evidenced by a specific expected rate of gain 
per day (I use WHO charts.....)

Good luck!  Some of these cases DO make your hair stand on end, 
yes..., but your instincts are good!!

Pamela Morrison IBCLC,
Rustington, England


Date:    Mon, 6 Jul 2015 15:48:04 +1200
From:    Jacquie Nutt <[log in to unmask]>
Subject: Diabetic mother with sudden change in feeding pattern

Hello All

I saw a diabetic client (type 2) last Thursday who had fallen into the trap
of adding formula supplements, to the extent of now offering 80 - 120 mls
after each of the daily 7 feeds.  She wanted to return to full
breastfeeding, so we discussed a plan where she would add more breastfeeds
and slowly wean from the formula over some days.  Luckily the baby latches
and suckles well.

When I saw her the next day, she had breastfed religiously every 2 hours
day and night, dropping the formula at once, to my horror.  She said her
breasts felt more full already - could that really have turned around so
fast?  The 6 week old baby seemed happy enough on the breast, and I will
follow up his weight carefully (he was a bit borderline previously, despite
getting 560 to 840 mls formula per day as well as breast milk of unknown
volume).  My hair just wants to stand up on end each time I think about it.

While it's great to have a mother so committed to turning things around, I
also have a concern about her blood sugars.  Is the sudden feeding and
possible increase in supply going to play havoc with her blood sugars and
metformin needs?  I will see her again tomorrow, though she claims to have
everything in hand by now and I fear she may renege on our appointment.
Should I insist she sees her doctor to have her blood sugar levels checked?

Jacquie Nutt IBCLC


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