One of my partner's and his wife had a new first baby on 5/3/04.  He was
born via elective c-section due to breech at 6 lbs 9 oz, 39 wks 2 days.  I
did all the prenatal care, and mom was very determined to breastfeed.  They
chose to deliver at a different hospital, though, once baby was persistent
breech, so I was not present for first 3 days.  Baby was vigorous at birth,
but was given 1 oz of formula for a blood sugar of 38 (assymptomatic, never
rechecked, mom not given the option to put baby to breast, grrr.)  Anyway,
he and mom were seen by the IBCLC at the other hospital, with some help for
a shallow latch.  I saw him on day 3 of life (about 72 hours, actually) and
he was down to 5 lbs 12 oz.  I helped mom again in the office to latch him
deeper (large nipples, small mouth)  Her milk had just come in and I thought
he'd turn around after that.  2 days later, though, he was down to 5 lbs 9
oz and quite jaundiced.  He also had had only 1 stool in 3 days.  At this
point, I sent the dad out for a Lactina, and had mom start pumping post
every feeding and supplementing this milk by bottle (her choice of
supplement method.)  I saw him again 48 hours after starting the pumping,
and he was up to 5 lbs 13 oz.  Jaundice was gone, baby was vigorous and
active, and had had 4 stools already in the early afternoon, and many wet
diapers.  I snipped his mildly short frenulum, too, and again helped mom
with latch.  I think we're doing fine, now, except that his little mouth
needs to grow, and he needs a few days of good caloric intake to help him be
more vigorous at the breast.  Mom is a little scared about not making enough
milk for this baby, but has seen her milk volumes increase greatly with the
pump.  Her own mom, who nursed her brother for 2 years is coming for several
weeks on Saturday, and I'm hoping that will help the confidence issue.  Her
mother in law is my pediatrician partner, who really wants to be supportive,
but has a tendency to introduce doubt at every turn.  I've spent about as
much time reassuring the in-laws (a pediatrician and general surgeon who are
my other partners) as I have the mom!
Here's the question.  The pharmacist who rented them the pump was reluctant
to rent it and recommended they just buy a Pump in Style.  The dad (the
physician) wants to know why they shouldn't just do that.  I said that I
always recommended a rental grade pump when establishing milk supply was at
issue, but that I'd ask you all if a Pump in Style would be sufficient for
this kind of situation.  Mom will otherwise be a stay at home mom, and has a
Medela Mini Electric which she could use if the occasional bottle is needed.
   Is there a significant difference between the PIS and Lactina?
Jennifer Tieman
Family Physician (and sometimes family counselor!)
Mom to 4, including nursling Caroline Rose born 5/31/04

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