I went to see this mom full of foreboding as she'd said they had "a good
night" because the baby had slept all night long.  Along with everything
else that sounded pretty bad.  But after seeing them I am inclined to think
it isn't as bad as that -- and may, as she thought, have been at least
partly because of a full tummy (formula staying down better).
There are certainly plenty of worrisome signs.  The mother has indeed been
diagnosed with PCOS in the past (which apparently her MD, and the baby's
MD, and the LC they saw either don't know, or don't recognize as a red
flag).  Her breasts were tender before any other sign of pregnancy but did
not enlarge at all or have any other changes.  She not only had no
engorgement but has not felt full, heavy, tender etc since the birth.  The
only thing is that she sometimes finds them "lumpy" to the touch during a
feeding.  The birth was induced at 41 weeks by ROM.  Baby was kept in the
nursery the first night except for three feedings, "roomed in" most of the
rest of stay.  She said the first 3 nursings after birth went well and the
rest of the time she was trying to breastfeed hourly and the baby spent
maybe a total of 10 mins feeding in an entire day.  No one showed her how
to hold baby or achieve a latch, apparently.  No pumping till after she
went home, with a pump she had no success with.  Baby has been nursing for
long, apparently ineffectual sessions and fussing a good deal by
night.  Wts 8-7 at birth, 7-15 at discharge, 8-1 at 12 days.
On the other hand:
The baby is nowhere near as dehydrated or puny as I was afraid she might
be.  Her face looks good, she apparently spends much of each day either
snoozing or cheerfully alert, and her skin feels good (admittedly all this
is after 2 days of formula "top-offs" every 2-3 hours).  The really
dissatisfied sessions were at night and turned out to be when her parents
were dutifully trying to return her to her crib from their bed; they like
the idea of sleeping with her and will probably do so now
(non-smokers).  Baby was showing no signs at all of reacting to the formula
when I saw her and at least some of her vomiting was probably due to dad
giving her 4 oz in a single binge 24 hrs earlier; no vomiting since
then.  Mother is cutting way back on her own dairy intake, as her doctor
did discuss that with her.  Really a beautiful baby.
Mother's periods did become regular a couple-three years ago, and she did
get pregnant w/o intervention, apparently not all that long after starting
to try.  She did have early breast tenderness.  The baby was sleeping but
we undressed her and the baby grew interested in feeding.  When I helped
them latch, the baby latched a bit sloppily but nursed with comfort for the
mother for maybe 7-10 minutes.  Good jaw action.  Signs
of  swallowing.  Inclined to stop and snooze, but I taught the mother
breast compression and it helped with that.  The baby came off
spontaneously with that "I'm done, call me next year" look on her face
(folded milky lips).  The mother said this was new; she could clearly
differentiate between the baby's behaviors at this feeding and the
unsatisfying ones.  Burped, diapered, offered other breast, baby acted full
and uninterested.  I taught the mother to hand-express (for enticement) and
she readily expresses a drop or two.  Taught her to breastfeed lying down
and baby did eventually snack a little on the other side in this position.
So I really felt this was not as much of a train wreck as I had feared it
would be.  Her plan when I left was to nurse a lot, taking the initiative
every hour or two, do a lot of skin to skin, sleep with baby, rent a good
pump to use after a feeding or if baby slept longer, not let baby
sleep >3-4 hours, spend the weekend holding and breastfeeding, supplement
w/formula if baby was unsatisfied after breastfeeeding or not
peeing/pooping enough (per LLL Enough Milk tear-off sheet I left her).  She
may get a supplementer at some point.  Not clear how much of her low supply
is hormonal/constitutional, so that medications may be needed, and how much
is due to poor latch, poor advice, misreading baby's cues, etc.  The mother
is very willing, very loving, very maternal but also somewhat clueless, and
rather anxious.  Lots of family support: mother, brothers, husband all in
same house, all very pro-breastfeeding though clueless, and all adore the baby.
She does have a tendency to readily fall in with suggestions but then not
really follow through, so there may still be glitches.
Elise

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