hi sally
tried to send this last nite but my computer fainted in mid-post.
i think you did a fine job and you've already identified a couple areas
where you might do differently next time. my motto is live and learn, we all
do it.
i agree if things looked basically good at day 3 i may not have done a fdg
observation, unless there were risk factors of which a bili of 13 i think
would be an indication of less than great fdg (unless other factors like
bruising were present to account for this). that is a tough call as when
milk is in and everyone is getting their acts together, moms and babies
often turn right around and do great.
from day 3 to day 10 or 11 baby only gained 1 oz. also mom felt her milk was
going away. these were big red flags which you identified. here is where i
would get more aggressive. yes, i would calculate how much baby needs to
take 2.5oz/# and divide it into q2 or q3 hr fdgs. it would be expressed milk
or formula (if needed). if baby wants more, give more. if baby won't take
these minimums i want to know about it asap. then you should follow this
baby very closely like every day until things turn around, i.e.
supplementation decreases and mom gets to full bf. mom needs lots of
support. these babies usually gain very quickly once they are getting adeq.
amts of milk. i like a gain of 5-8 oz per week but most of these "cathcing
up" babies gain even more til they catch up.
you have great physical assessment skills and sound LC practices. (see,
nurses do make good LCs!)! you will change your practice based on your
experiences and outcomes, as we all do. you will just get better and better
!

Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA


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