Hello,
My name is Nancy Nurmi and I have been lurking for a couple of years.
Usually there is not a need to ask questions because they are asked
by others and no need to make comments because wiser people than I
have perfect responses!  I am an LC (IBCLC) who has a very, very
limited private practice - mostly problems of damaged nipples,
latching problems, engorgement, hyperlactation, sleepy babies - etc.
I need your expertise with a first time mom:
History:  normal pregnancy, breast changes normal during pregnancy,
longer but normal sized nipples with small areola
- induction (Pit)after 8 1/2 hour labour, failure to progress
(effaced/little dilatation), baby bradycardic, demerol X 2, c/s with
epidural,(you've heard this story before) mom's BP remained normal
throughout, postpartum mother suffered a large hematoma length of
incision line (she was told she lost a volume of blood in that about the size of a tennis ball), hgb
100 on day 2 and down to 90 the next day), I did not inspect her
incision)lochia normal.
- baby sleepy throughout hospital stay of 3 days, allowed to sleep
7--8 hours at night in the nursery, only supp'd once for 30 cc of
formula, nursed perhaps 3-4 times a day while in hospital, mother
indicated breasts never became "full"
- at home parents continued to wake baby q3-4h, no supps and thus
little voiding and occ'l very small stool, no audible swallowing at
breast
- day 6 - visited by nurse who began SNS at breast and called me
- assessment that evening: soft breasts, mother able to express some
drops of milk (hadn't been able to before this, but said she wasn't
sure if she was doing it right), babe positioned fairly well but
latched onto nipple only not onto breast
- reviewed positioning, body alignment, leading with chin, very close
to breast, gentle chin retraction to open mouth, on occasion long
draw and very quiet swallow, no nipple damage/problems
- I suspected that the baby had been nipple feeding all along and
thus not stimulating supply by good emptying so worked on the latch,
supplemented with SNS and rented a pump (double), feeding q3h (he
doesn't demand) & pumping after
- 48 hours later (pp day 8),getting nothing by pump (I checked it -
I'm an old maternity nurse - I can do pumps!!), parents have worked well
with the latch (suck assessment- he is strong and takes my thumb way
back to the soft palate (I always let them I don't force) and tongue
in the right place) and he takes more of the breast tissue in now
but still no audible swallow
- mother is discouraged but not giving up
- I encouraged them to keep up what they are doing, she is going to
try pumping manually, massage etc. and I suggested fenugreek
- Questions: What is a reasonable time to try to bring in the milk
this way before I start thinking about other causes of delayed milk
or consider domperidome?  Or are there other things I could be
missing)
(I'm going through the traumatic birth,retained placenta, pituitary
problems from blood loss etc. thoughts(especially since she didn't
get any fullness in the first few days)
- she takes baby for weight on Monday (day 11), which might be down
because he lost >10% before discharge, but he is taking 2-3 oz by SNS
q3h - so I hope it is ok
- I can imagine what the doctor will be saying (dark ages here when
it comes to discussing BF with doctors - LCs? who are they and what
do they know?) - just give him the bottle and forget BF)
- this is the most complicated case I've had and I plan to empower
the family with info to keep going (they are very interested and want
to know so much- they are not afraid to challenge the doctor if they
have to - the father said - they want to breastfeed)
-- Am I worrying too soon?  Please help.

Nancy
Nancy Nurmi
[log in to unmask]
10 Hanley Street
Thunder Bay, Ontario
CANADA  P7A 6V2
(807)345-1013