I have a mother with some psychiatric diagnosis (she won't tell me exactly what
it is or the history exactly) but apparently the father also has something,
there is a strong family history and her 6 yr old son has some problems along
the autistic (high inteligence) spectrum (they also didn't say the exact
problem the father said opositional defiant but it seems like more than that to
me) the father said that he's been on 4 different meds and none of them have
helped, so in that light its easier to understand her thought process and
decision making.... she came to me for the first time for this baby/ pregnancy
to discuss what she had already decided for a lactation plan- this is her third
baby, the first 2 she had gone off her meds for pregnancy and breastfed for a
short time (few months and partial?) and needed to go back on her meds which is
an antipsychotic/ antischizophrenic medication. But she did also have lactation
problems (probably from partial breastfeeding) and she said that she went to a
LC (who I know is a very good one) and she just emotionally couldn't handle the
regimen of pumping that LC had reccomended. This pregnancy she had to be on a
med during the pregnancy and during lactation--- whether its compatible or not
is not relevant she made up her mind that she doesn't want her child to have
any of it. Its an L3 by Hale and determined to be about 2% relevant infant
dose (risperidol) with a half life of ? I can't remember 7-14 hrs about, so she
is hanging onto that half life number and after her own reading decided to not
give any of her milk until the end of the longer period- so if she takes the
med at 9pm she's not giving any milk until at least 3 pm and prior to that she
wants to pump to empty her breasts... Now in a prenatal consult I discussed
with her milk supply and the need for frequent pumping to keep it up and that
the baby MAY get nipple confused or refuse the breast, she's interested in just
"comfort nursing" but only from 3pm to 9pm, and she is aware of adoptive
breastfeeding, so we also discussed the possiblity of using a lactaid.... Now,
she's around 43 yrs old and there was an abruption with a lot of blood loss
(emergency c/s) at 39 wks, baby had low apgars and was in the NICU for 2-3
days, but by d/c the baby seemed well, of course I couldn't check a latch b/c
she won't do it except between 3-9pm. I was pleased that at least she gave
expressed breastmilk 3x the previous evening. Okay, so now she says that she
knows emotionally, she will not be able to pump in the middle of the night b/c
she needs her rest. Right now she went to a mothers respite home for 2 wks
which is like being in the hospital with nurses and a nursery!!! Oh I had also
urged her to do a lot of kangarooing/ skin to skin- which she is aware of but
also reluctant for modesty reasons!!! So she wants her baby to latch 2-3 times
in those hours and for this to last for about 6 months! In the first 10 days I
just spoke to her by phone and she said that she has only pumped about 2x a
day. Also that her nipples hurt a bit when the baby is latching, I told her
there is a possibility of thrush (of course but the doctor over there said that
the baby doesn't have any thrush) on HER nipples but also very likely that the
baby was not latching well because of all the bottles, I had reccommended they
get a more domed short nipple teat, but she's saying for now, the nurses there
use their own bottles etc... (not very take charge personality) anyway, I'm
warning her that she's going to dry up and that her baby may start to refuse
the breast. I'm urging her to pump maybe for only 10 mins (she was doing 30)
at something like 7am, 9am, 11am, and 1pm then at 9pm and 11pm. That would be
at least 6x plus 2-3 direct breastfeeds. She wants to know what is the minimal
she needs to pump in order to be able to breastfeed/ latch her daughter for
about 6 months????? am I wrong to be so negative? I'm trying to be realistic,
I told her I can't give her numbers, but most mothers I see who pump only 2x/
day dry up in a few weeks and also many babies just start refusing the breast.
SO.... thats my question.... How would YOU counsel her???? What would YOU tell
her about minimal pumping so that the baby will continue to latch??? Oh, she's
not doing the lactaid now but I will show it to her when she comes back from
the respite next week.
Please private email me since I've been having trouble keeping up with the
volume of lactnet lately.
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