Dear Lactnet teachers,

I've recently made a house visit to a mother who had delivered her baby on 16 April and at the time of visit was 19 days old. Birth weight was 3.01kg and labor was induced at 41weeks. Vaginal birth with minimal medications. Labor lasted about 16 hours and baby did not nurse on the first day and slept practically through the night.

Mom had contacted me 7 days post partum via email and mentioned that baby was not able to latch on well and at that time was being supplemented with EBM via a syringe which mom had expressed every 2hrs. I gave her a link to Dr Jack NEwman's positioning and latching videos with compression via You Tube and all was going well until 2 days back when mom requested that I come over and have a look at her baby nurse as she was "worried" that her baby was not gaining weight and was suddenly fussy at the breast.

Mom had told me that she took some weight measurements at home using the bathroom scale and her 1st reading on 29 April was 2.9kgs but went down to 2.7kgs on 5th May. I had explained to her about the various factors that might have influenced the reading (different scale, wet/dry diaper, clothed/not fully clothed baby, just fed/before eating. 

Baby was also having longer stretch of sleep and would only wake up for a "short feed". It seemed that baby was most happy to sleep than eat. Jaundice was mild and was resolved by 6th day post partum without the need for a bili light.

From my observation, mom has no issue with milk supply (we did a hand compression "test" and mom showed me her stock of EBM). No signs of any nipple trauma. Baby was just in time to nurse and we had tried the cross cradle hold much to baby's disagreement and finally settled on an upright position (Australian hold) where baby was able to nurse on for about 30-40minutes. During that time, there were audible and visible signs of an active swallowing with frequent rests. Mom did the breast compression and baby immediatly nursed again. Baby came off the breast by herself.

Baby was looking really "thin" and mom informed me that the initial wet diapers were like brick dusts and recently it resembled like specs of yellow/orange patches on her disposable diaper. Diaper output was not satisfactory. We had set a breastfeeding plan for mom to nurse every 2hrs and to wake baby up to feed and at the same time I had gave her the number of a private pedeatrican to bring her baby for an evaluation. I mentioned to mom that most likely the pedeatrican will call for a temporary supplementation on top of the breast feedings until baby's weight is at a satisfactory level again.

Mom was not planning to make a visit to any doctor/clinic until baby is about 1 month old when she is due for a follow up at the gov hospital where she had delivered. The midwives that made the home visits during the initial post partum days did not observe the entire feed and was only there for "a mere 2minute" according to mom. The main purpose of the midwife visit was to ensure that the umbilical cord had dried up "properly". (this is not the first case that I had attended to hearing the mother telling me the main purpose of the midwife's visit)

My next follow up visit to the mom is this Tuesday.

As this is my first case of such, I would be very much grateful if there are any other suggestions/methods that I am able to apply to help this dyad.

Thank you all in advance for your help.

Warmest,
Moe Fletcher, CLEC
Brunei Darussalam

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