I saw a mom and baby today 6 days post-partum.  I delivered the baby, a very
fast, unmedicated delivery.  Baby was 8 lbs 10 oz at birth (3/8/03), 7 lbs
15 oz at discharge on 3/10/03.  Today, on a different scale he was 8 lbs 4
oz.  While weight gain is fine, this baby is driving his mom nuts.  Baby
latched well for the first few days, then begin to struggle to latch,
causing mom soe nipple soreness.  She would often have to relatch him
several times to get a comfortable latch.  The soreness is nearly gone now,
but baby tends to be sleepy at the breast.  He wakes to feed, nurses well
for a few minutes, then goes to sleep, but wakes and screams if taken off.
Once awake, he goes back to breast readily, but falls asleep again quickly,
and this cycle is repeated.  He often takes well over an hour to finish a
feeding in this manner and then wakes again in 10-20 minutes to start over.
 He is stooling 6-7 times a day, and wetting about the same.  Mom reports
his urine was dark yellow or orange the first 4 days, but now nearly
colorless.  Mom is really tired, and is also struggling to care for her 20
month old toddler, and 5 year old as well.  Her first baby nursed only a few
weeks, second about 9 mos (lots of problems in the beginning with both of
them, I took care of her with the second and after the first month they were
a very content nursing couple.)
today in the office, he latched well and painlessly, and nursed vigorously
for about 10 minutes without falling asleep.  Mom reported it was the most
vigorous he'd been in several days.  She was very relieved with his weight
gain and felt inspired enough to commit to continuing for at least a while
longer.  (although she suggested I come home with her, since the baby did so
well in my office!)
I suggested she try breast compression, and switching sides when baby starts
to get sleepy, but wondered if there are any other ideas to help this little
guy transfer milk a little faster.  Mom is more than willing to feed
frequently, but constantly is kind of hard on her.  The IBCLC from WIC will
be seeing her Tues., 3/18 also.  If anyone has any other ideas, I will call
her and give them before then.
Jennifer Tieman
Family Physician
Mom to 3, and new baby #4 expected 5/31/03

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