I have been working with a mother for about 6 weeks.  She had a very
difficult delivery and a slow recovery.  Initially she called me telling me
she couldn't handle baby being latch-on all the time, she was exhausted.
 Baby was literally latched constantly.  She couldn't come see me because she
had gone to her mother's to recover and the father runs a business 16 hours a
day.  Baby sounded dehydrated and like he was getting into trouble.  I said
feed the baby in no uncertain terms.

Finally at about 10 days the mother made it in to see me.  Baby was below
birth weight and the ABM mother was giving was causing diarrhea.  Mom
insisted that baby didn't like the ABM and preferred the breast.

Mom never became engorged after the delivery.  Little swallowing at breast
and a terrible latch.  I corrected the latch.  Sent mom home with a pump and
instructions on how much to supplement.   Mom was so stressed and was going
home w/o any help or support so I put off moving baby from bottles to
alternate feeding methods until the next visit.

Next visit baby was having more trouble with diarrhea.  Dr had suggested a
hypo allergenic ABM which baby refused so Dr said put baby back on Soy.  I
gave mom an alternate hypo allergenic ABM to the one the Dr had suggested and
we discussed allergies at length.  Mom has quite an allergy history.  Mom was
only pumping 2-3 x per day.  No time, she said, baby was constantly at
breast.  Recorrected L-O at this point and tried finger feeding baby or
syringing at breast.  Baby would not stay at breast when ABM was introduced,
w/o ABM baby latched-and relatched constantly and did not do well w/ finger
feeding, kept breaking suction an pulling away.  Mother was very
uncomfortable with the thought and still completely stressed.  I decided not
to push it.

Mom went home promising to try to pump more but the Jewish holidays prevented
this.  She kept giving the breast very frequently, and giving supplemental
ABM.

Friday she called me in a panic.  Baby was refusing ABM altogether.  On
questioning her baby was having 6-8 wet diapers and 4-5 stools after 2 days
off ABM.

Monday she called me first thing.  Saturday her breasts had engorged and she
didn't know what was wrong.  She took baby off breast for 24 hours because
they were so painful.  I told her it sounded like normal postpartum
engorgement and get the baby back to breast.  She came to see me Wednesday
and baby is back at breast and engorgement is subsiding.  Baby looks great!
 Weight is up 1#1 oz in 19 days.

After 5 weeks her milk finally came in!  Lucky for this baby because he seems
very allergic.  Mother reported to me during the visit, as an aside, that she
is still bleeding heavily (soaking maxi pads).  She has a postpartum
appointment tomarrow so I told her to be sure and discuss the possibility of
retained placental fragments with her HCP.  I also called ahead to let them
know what I have seen.

Denise Parker, BA, IBCLC