I am working with a mother of a 7 day old baby. Baby is very yellow, and
came to me on day 5, terribly sleepy, weak suck at breast, ineffective suck.
Baby was down 1 lb from birth weight. Mother had a small batt. pump.

I measured, and baby took 28 cc from breast, and then another 50 cc from
SNS. Instructed mother to pump after each feed, and use milk to supplement
via SNS at next feed, feeding every 2 hours on cue, or so.

Mother went home, couldn't wake baby all that first night. She did not start
supplementing until noon the next day...when she could get it together. Very
educated parents. Things have improved, though she has only been able to
pump approx 25-35 cc with double pump. Is terribly stressed due to work
commitments this week ( a huge conference is happening)....baby takes all
pumped milk via SNS at each feed.

Output is approx 2 bowel movements and plentiful wet diapers, but today, on
day 8, baby is still very jaund., and has gained no weight at all. WIll see
doctor tomorrow. Alert and active, but just not gaining.

Mother contemplating stopping SNS feedings, pumping, and is "ready to throw
pump through a plate glass window."..with some wry humor, she tells me this.
During visit, she was able to pump ( in my presence) 45 cc.

She is contemplating quitting. I think that she has a baby who is not yet
gaining, and who is not adequately stimulating supply yet.  I faxed her MD
today, and also told her that one option is to use formula, either via SNS
or any method she wants just to GET THE KID GAINING WEIGHT.  She is
contemplating things.

Can anyone think of anything I missed?  I don't think she has retained
placenta, or low thyroid. She feels ok, just is concerned that baby is not
gaining, and that her breasts don't feel as full as they should ( she does
feel let down, she says), and is really sick of pumping, etc. suppl. via SNS.

Thoughts? WHAT AM I MISSING?

Kathleen

When she came over to weigh baby today, she felt that the pump was not
working well, so I exchanged the entire pump and kit, and she was happy with
that.

Kathleen B. Bruce, BSN, IBCLC co-owner Lactnet,TLC, Indep. Consultant
in beautiful Williston, Vermont, USA
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