Thanks to all of you for you very creative and ingenious methods for
securing supplementers.  They included using Duoderm (not sure of the
generic name--this is a sort of spongy adhesive dressing used for
healing and protecting wounds, especially decubitus ulcers, AKA
bedsores) instead of tape, using hairdressers tape, using small
Bandaids, butterfly wound closures, or a tape "tunnel" to guide and
secure the tubing without removing tape between feeds, leaving the
supplementer in place between feeds and leaning over sink to flush the
tubes, or sliding the tube in after latch with a dampened finger.  Wow!
What a lot of great ideas.  Someone also suggested "hydrogel tape."  I
asked the wound care specialist about this; she didn't think it would be
sticky enough.  Has someone used this and found differently?

My client has not used the supplementer at all since my last update.
She had been pumping every four hours, but had only collected 2 oz. of
milk in 3 days, and had pumped almost nothing the last two times she
pumped.  So, she decided that on Friday morning she would begin pumping
every 2 hours.  She was really excited when she called Friday evening
because she had pumped 2 oz. already since she had begun pumping every 2
hours.

She is still bottle feeding supplements.  She was concerned about
varying amounts of intake at feeding.  She wasn't sure how to avoid
wasting the milk in her two four ounce bottles, so I suggested that she
pour off a little from a four-ounce bottle into the just-used 2 oz.
bottle when baby wanted a little more than 2 oz.  (I know she could just
keep it in a pitcher, but wanted to make the changes as small as
possible.)

Hopefully, she is becoming more adept at reading her baby's signals.
She said sometimes the baby refused the bottle when offered and she
realized baby need to be changed, not fed.  She said she really was
homebound on an every 2 hour pumping schedule.  I gently told her that
she would need to be for at least a couple weeks if she were going to
improve her milk supply; she seemed okay with that.  I also suggested a
sling for times when baby just wants to be held.

She asked if she still needed to call every day or if she could call
every few days.  I felt this was a very good sign, showing that she is
regaining confidence in herself.  I think (hope) she has rounded the
corner.

BTW, I think the reason the weight gain looked acceptable despite
inadequate intake was that she was probably IUGR (intrauterine growth
retarded) to start with.  Judging from the size of the parents, I would
have expected a larger baby.  Incidentally, don't think I mentioned mom
was a gestational diabetic.  No thyroid problems.

Thanks again for all your great ideas.

--
Bonnie Jones, RN, ICCE, IBCLC
from the sunny S.W. USA
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