Has anyone ever worked with a mom with such a letdown that she can get 3 Oz in 20 seconds with minimal stimulation? I have tried everything with her including reclining and nipple shield and pumping before nursing and nothing helps. I witnessed this in my office and couldn't believe it! Unfortunately she cannot nurse her 4 month old more than 7-10 seconds before he gives up crying.
Any suggestions would be greatly appreciated!
Waiting on blood work results this week too. She has high blood pressure and I'm praying we find an answer there.
Thanks
Wendy Shore RNC, IBCLC
In PA, USA
Sent from my Verizon Wireless 4G LTE smartphone
<div>-------- Original message --------</div><div>From: LACTNET automatic digest system <[log in to unmask]> </div><div>Date:02/26/2015 12:01 AM (GMT-05:00) </div><div>To: [log in to unmask] </div><div>Cc: </div><div>Subject: LACTNET Digest - 24 Feb 2015 to 25 Feb 2015 (#2015-92) </div><div>
</div>There are 7 messages totaling 260 lines in this issue.
Topics of the day:
1. Adopting "The Sacred Hour" (3)
2. "chunky milk" in exclusive pumping mom of preterm infant (3)
3. Hospital requirements for Lactation nurses
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Date: Wed, 25 Feb 2015 09:01:16 -0500
From: Donna OBrien <[log in to unmask]>
Subject: Re: Adopting "The Sacred Hour"
Sheila, Thank you for sharing how you went about making the change to support the Sacred Hour. I have in mind to go through similar steps, with the presentation to our Nurse's Council with Reps from L&D, PP, And NICU on the Council. Would you be so kind as to share with me the actual information/plan you used to present to the different entities: staff, Physicians, Admin, etc? I have gathered so far the AAP Peripartum Recommendations, the Academy of BRF Medicine Protocol #5, AWHONN Core Measure Duration of Uninterrupted Skin to Skin, Maternity Care & The Microbiome: How Birth Practices Dictate Future Health by Penny Simkin, information from Dr. Raylene Phillips (Loma Linda University), and and recommendations concerning ways to prevent Sudden Unexpected Postnatal Collapse from the Journal of Human Lactation (J Hum Lact February 2015 vol. 31 no. 1 47-52 ) but perhaps you have it all together in a written plan?
Thank you for anything you can share with me. Also, do you have a written P/P for this?
I realize it takes time to gather the information, but if you could possibly I would be grateful. I have not heard from anyone else.
Thank you again,
Donna
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Date: Wed, 25 Feb 2015 19:02:41 +0100
From: Rachel Myr <[log in to unmask]>
Subject: Re: Adopting "The Sacred Hour"
I'm working on exactly this project at the moment myself. Sheila, you wrote
that it is well worth it. Could you describe the outcome as you perceive
it, either here on Lactnet or privately to me? I know what I am hoping to
see in my ward, but I would really love to hear from other units who have
successfully implemented it.
Rachel Myr
Kristiansand, Norway
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Date: Wed, 25 Feb 2015 13:35:38 -0500
From: Rachel A Miller <[log in to unmask]>
Subject: Re: "chunky milk" in exclusive pumping mom of preterm infant
Kathy,
If this is the case, do you think using the 'milk shake' concept (I beleive it's Dr. Smillie that uses that term) of suggesting the mother use breast massage/very gentle shake of the breast to 'remix' the separated fat back into the milk before milk expression/feeding would help with that?
She has started to notice that the 'chunks' are more obvious in the freshly pumped when she has longer times between milk expressions.
Thanks for your thoughts!
Rachel
Subject: Re: "chunky milk" in exclusive pumping mom of preterm infant
Hi Rachel,
This is just a thought, but I have personally experienced this with my daughter. Her milk is very high in fat content and frequently comes out looking like pasta noodles! This tends to put her at higher risk for plugged ducts so she takes lecithin as an emulsifier which works beautifully. In the absence of pain, fever, foul odor or unusual color or bleeding, it seems possible that this mom's milk is just healthy and high in fat.
Hope this helps - good luck!
Kathy
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Date: Wed, 25 Feb 2015 15:57:45 -0500
From: Michelle DeArmond <[log in to unmask]>
Subject: Hospital requirements for Lactation nurses
Looking for some data on National Standards of Care for lactation inpatients. Does your hospital, in the U.S., require that lactation nurses have their IBCLC's. Just wanting actual data to compile not beliefs. If anyone is aware of this compiled data, I would love to know that as well.
Respectfully, Michelle DeArmond RN, BS, IBCLC
Lutheran Hospital, Ft. Wayne, IN.
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Date: Wed, 25 Feb 2015 16:10:07 -0600
From: Pat Young <[log in to unmask]>
Subject: Re: Adopting "The Sacred Hour"
I like " The First Hour After Birth: A Baby's 9 instinctive Stages" and "How to Hold Your Baby Skin to Skin", both by Health Ed Assoc and I don't have any financial interests in their co :-)
I think it helps professionals to see what moms are reading, so they can understand where mom is coming from and catch up :-) Pat in SNJ
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Date: Wed, 25 Feb 2015 20:58:26 -0500
From: Amy Wagner <[log in to unmask]>
Subject: Re: "chunky milk" in exclusive pumping mom of preterm infant
This discussion makes me think......I wonder if dehydration would contribute to this change in milk consistency? Is milk concentration affected by dehydration?
Amy Wagner BS, RNC, CCES, IBCLC
Sent from my iPhone
> On Feb 24, 2015, at 11:51 AM, Rachel A Miller <[log in to unmask]> wrote:
>
> I have a NICU mother, expressing for her preterm infant. Infant is 12 days old and mom has done a fabulous job of exressing and establishing milk production of about 800ml/24 hours. Late yesterday she called about the milk in 1 of her breasts has "started coming out of my breast with chunks in it".
> She denies any signs of breast redness, tenderness, or pain and NO other maternal signs like fever, etc. She says breasts feel fine and milk volume is the same, but 'just has started having white chunks in it from the 1 breast.' Milk color is 'normal white'.
>
> Days ago, staff told her they had no more room for her milk right now and to keep all milk at home (except for 1 bottle of fresh milk daily) so she's not brought any of this 'chunky' milk to the hospital. She's packaging and labeling it separately from the other breast's milk and just freezing it. I'm not sure I'm getting an accurate picture of what she is describing and she plans to bring a sample in for me to see today (if the weather doesn't keep mom from visiting). But in all my 34 years of working with mothers and babies, I've never had another mom describe what she is describing.
>
> I appreciate any thoughts or ideas of what it might be!!
> Rachel
>
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Date: Wed, 25 Feb 2015 23:37:00 -0500
From: Mary K Medenwald <[log in to unmask]>
Subject: Re: "chunky milk" in exclusive pumping mom of preterm infant
Hi Rachel, yes, I was always taught to "shake the girls" as a way to suspend the fat droplets, warm the milk and get it flowing, especially the thicker hind milk.
Certainly can't hurt and seems a good place to start with this mom.
Good luck!
Kathy
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End of LACTNET Digest - 24 Feb 2015 to 25 Feb 2015 (#2015-92)
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