Dear Friends:
   I am very frustrated after a home visit I made today.
   The mother had never noticed the breast fullness after delivery that one might expect with a first baby. The baby, at age 11 days, is still 10 ounces under birth weight. Peeing lots, but pooping once a day, dark color. Mother still having bright red lochia, enough that she is wondering how long it will persist. Baby latches perfectly to the soft breast with a fabulous tongue, perfect lip flanging, and excellent sucking. Listening with a stethescope, I heard only sporadic swallows. Scale showed 0.3 ounces of milk transfer after 5 minutes on one side and 10 minutes on the other; total 15 minutes. Baby falling asleep; also has a hollow and hoarse sounding cry. Mother reports that MD made comments at delivery about how large placenta was.
     Baby took nearly 3 ounces of formula after nursing; 1 from a cup and two from a bottle.
     I recommended supplementation with formula and calling the doctor to rule out retained placental fragments.
    Doctor spoke with the mother. "All the placenta came out; I saw it. Ultrasound doesn't always work. If you are soaking one pad per hour, come to the ER. Babies can breastfeed when a mother is pregnant, so there is no connection between the bleeding (which is within normal limits) and the low milk supply."
   Mother is now caught between me and the physician. Feels like a pingpong ball. Meanwhile, breastfeeding is being compromised, because baby will catch on instantly that nourishment comes from the cup or bottle, and not the breast.
   Mother has requested that I not page the physician to talk directly, because physician is very busy today. I shall make a home visit tomorrow to set them up with a SNS so that baby will still want to go to breast.
   AAARGH!! What about prevention? Why does this mother have to hemorrhage before she is taken seriously? Why doesn't the physican know the difference between autocrine control and the milk-stat setting in the first few weeks postpartum?
   Thanks for listening.
   warmly,
Nikki Lee RN, MS, Mother of 2, IBCLC, CIMI, CCE

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