I would like to clarify some of the information that Martha posted on
our
client with insufficient milk. I cared for them during birth and for
the
first 6 hours postpartum, the babe was not suctioned, no separation, at
breast within 30 minutes licking at nipple but no latch. Babe first
latched at 2 1/2 hrs after birth which is very late compared to our
normal 20 minutes and this was due to the transfer to the hospital and
the extensive repair work, still they were never separated and babe was
not bathed. Did feed well twice but fussy as though she had a sore
head.
The weight loss was not the only criteria on which decisions were based,
by day five with 15% weight loss the babe was looking very hungry and
with borderline voids and only one dark green stool. Mucous membranes
were dry, babe was feeding frequently and vigorously with few audible
swallows and no open-pause-close type feeding. By the next day babe had
begun to be less vigorous at breast and very sleepy. This was a case of
rule #1 FEED THE BABY! If we had not been following this baby at day 2
and day 5, if there had been no intervention at all I believe this baby
would very likely have been seriously dehydrated by day 8. Fortunately
these parents would have and did recognize a problem and seek help.
We do weigh babies frequently and the vast majority are up to and beyond
birth weight by one week. But weight is not viewed alone, it is only
one
piece of the puzzle. Our babies are born out of hospital and go home
within 6 hours. Because of the short-stay we visit between 48 and 72
hours for a full assessment of mom, baby (including weight) and feeding
along with teaching. Most babies have lost less than 5% by this visit,
this baby was seen at 36 hours and had lost 10%, big difference!
We also have a Well Baby Clinic every week, parents bring their babies
from birth to 1yr olds in for weight checks and questions, we do this
primarily to provide a supportive environment but in the process we will
occasionally catch a baby who is not doing well based on reported
feeding patterns, weight and elimination.
This mom has excellent support from her partner, the only thing she had
to do was feed the baby. Dad kept all the records, set up and cleaned
the supplementer and pump, fed mom and kept things running smoothly.
She did nothing but feed the baby and pump for the first 6 weeks and yet
she has never produced a full milk supply. And yes it was, and still
is, a huge ordeal. This mom is very committed what she and we would
like to know is if any of you have any ideas of things we can do or
could have done to increase her supply.
Also not mentioned was the fact that this mom had tubular shaped
breasts,
one more so than the other and the milk production was lower on the more
tubular breast. We unfortunately did not start Reglan until after 4
weeks, based on a reference that I recently obtained from Clinical
Pharmacy Vol 12, July 1993, p479, the greater yields are gained when
beginning Reglan within the first month.
The supposed ductal thrush actually did resolve with 4 weeks of
Diflucan
as recommended by Hale. I guess it could have been something other than
thrush but since it did resolve with the treatment I am assuming that it
was. The yeasty stuff is never as straight forward as I would like it
to be.
Thanx for all the comments and the opportunity to clarify!
Janie Ginder RN
Nurse-Midwifery Birthing Center
Eugene, OR
>
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