>I was thinking about that case even before posting. What would I 
>done differently if I were the lactation consultant in that hospital 
>that saw this mother the first day? Yes to skin to skin, yes to not 
>limiting and no to scheduled feedings. In addition, I would 
>encouraged hand expression and re feeding colostrum to the baby. 
>Taking good history as well. She had no changes during pregnancy, 
>never developed breasts during puberty. She had very small and wide 
>spaced breasts, probably 10-12 cm between them. We did manual 
>expression when I saw her and got few milliliters. The baby's 
>bilirubin that day was high enough to start her on bili blanket. If 
>that baby would be a full term vigorous baby, do you think she would 
>develop a better milk supply?  We ( there are 3 IBCLC in our office) 
>saw mother and baby for the next 4 days, and there was no change in 
>her breasts. She added pumping and manual expression. Baby was born 
>around 2400g. Would you wait to start the supplement longer? Is 
>there research about mothers with severe hypoplasia/IGT developing 
>adequate milk supply?  Thank you!


Maya - I should  clarify I don't work in hospitals and rarely see 
mothers there. But I do help and support mothers in the early days, 
after they have been discharged.

2400g is a respectable birthweight for a 36 weeker - a good sign that 
the baby is pretty robust, with no IUGR.  So would it have been 
possible to wait a couple of days to see if a change from the 
'instruction' to feed 3 hourly to totally unrestricted feeding, lots 
of skin to skin/KMC, with a careful assessment of milk transfer, 
might have permitted things to turn round? That is, no supplementing 
(except possiby with mother's own milk if necessary, manually 
expressed at this stage).

It just seemed to me very early to say, on day 3,  'this baby needs 
supplementing as his mother is not likely to make sufficient milk for 
him'...she had not been given a chance to do anything, because she 
had been (very likely) separated from her baby, and she had been 
subject to very poor advice to limit feeds to 3 hrly.

I ask again,  why would a properly qualified person instruct a mother 
to limit bf in this way?

Heather Welford Neil
NCT bfc, tutor, UK


-- 
http://www.heatherwelford.co.uk

http://heatherwelford.posterous.com

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