In regard to the baby with reflux-could this be a really severe milk allergy or other allergy that she is reacting to in mom's milk and regular formula?? All this reflux always makes me suspicious.?
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From: LACTNET automatic digest system <[log in to unmask]>
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Sent: Mon, 7 Jul 2008 12:01 am
Subject: LACTNET Digest - 6 Jul 2008 (#2008-746)
There are 3 messages totalling 202 lines in this issue.
Topics of the day:
1. BRU and Medela pumps
2. Pump rentals and Lactation Services
3. Long- Gi specailist says no breastfeeding
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Date: Sun, 6 Jul 2008 17:18:22 -0400
From: Barbara Berges <[log in to unmask]>
Subject: Re: BRU and Medela pumps
As Sam Doak wisely said:
"Why not have these mothers call Medela, and have THEM teach them how to use
the pump? Medela can hire LCs to give correct information, after all, isn't
that part of product service?"
I just wanted to make sure that this comment was not lost in the exchange of
messages. It seems that this is a good way to put the responsibility where
it belongs (with Medela) and to benefit (pay) LC's who will be needed to
handle the teaching and problems related to these rentals.
Barb Berges BS, RN, IBCLC
near Cleveland, Ohio
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Date: Sun, 6 Jul 2008 15:33:43 -0700
From: Jeanette Panchula <[log in to unmask]>
Subject: Pump rentals and Lactation Services
There are so many different aspects of this topic - and I'm choosing to
address the one that is MY biggest concern right now in our area:
Even though Medi-Cal (medical services and supplies for low income residents
of California) WILL reimburse for pump rentals (at a rate of $2.72/day, they
require Treatment Authorization Requests- TARs- when the bill reaches $50,
which is a little over 18 days), there are few agencies that are approved
Durable Medical Equipment (DME) providers in many areas of our state - and
in order to become a DME provider you must have a business license, which
many IBCLCs in California do not have.
For this reason, for low income women, breast pumps are ONLY available
through WIC.
If not enough IBCLCs want to take this on, what if Babies 'R' US would
become DME providers and then breast pumps could be rented to women whether
they are rich or poor? OK, probably not but...
I know we are concerned about the abuse of breast pumps - mothers renting
pumps that do not need them, moms renting pumps when what they really need
is a careful assessment of her breastfeeding. These are legitimate concerns
- but they are not really Babies 'R' Us or Medela's responsibility....
I believe that responsibility is OURS
...WE need to get the word out to moms that they need/deserve a
breastfeeding assessment as recommended by the AAP.
...WE need to publicize/reach out/market/communicate the value of our
services withn our communities
...WE need to communicate to health care providers better and more
effectively so they realize that we ARE a valuable collaborator just as
Physical Therapists, Respiratory Therapists, Optometrists, etc. WE do what
they don't have the time or interest in doing - and we do it BETTER!
Babies 'R' Us doesn't teach how to put car seats into cars, doesn't teach
how to mix formulas, doesn't teach how to assemble the furniture they sell
or how to put on the baby carrier - and they won't take on Breast Pumps for
many good reasons including that they aren't qualified to do it, and in the
litigious society of the United States - they'd be CRAZY to take that on!
...so I think each one of us needs to decide what aspect of lactation
services WE want to take responsibility for
promoting/publicizing/collaborating with others ...and GO FORTH - not
because Babies 'R' Us and Medela are doing what they are doing but because
that is what WE need to do!
Instead of being angry and reactionary we need to be PROactive and positive!
When we reach out to others in a positive vein rather than in an angry
"those evil xxx or yyy" people, we gain respect and are seen as the
professionals we say we are!
Jeanette Panchula, BSW, RN, PHN, IBCLC
California, USA
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------------------------------
Date: Mon, 7 Jul 2008 03:12:31 +0000
From: SHAWN PARRY <[log in to unmask]>
Subject: Long- Gi specailist says no breastfeeding
Hello wise ones. I am a lurker. I have permission to post. Mom is eager fo=
r more input. Below is a summary of a friend/client of mine. I saw her arou=
nd day eight and thought maybe her milk was affected due to her gastric byp=
ass=2CI can't remember exactly what the test weight showed (I'm at home) bu=
t thought it was within normal limits. In fact I remember Michell saying sh=
e felt as though she had a lot of milk. I suggested she take her supplement=
s which she hadn't taken during pregnancy because she wasn't anemic. The ba=
by could have been more aggressive at the breast but she was 13 oz under bi=
rth weight and I felt she would do better when her weight increased. I am n=
ot sure if Michell continued her supplements=2C her pedi told her it would =
not affect her milk. I am confused by the GI doc's advice. It just does not=
make sense to me. Why can't she breastfeed and supplement? Couldn't we obt=
ain a crematocrit to assess her milk? What can this mom do to continue brea=
stfeeding? Thanks so much.Carla Parry RN IBCLCLakeland Florida Hi Carla=
=2C here's my info I had gastric bypass=2C Roux-N-Y 2-7-2005. I have lost =
127#. Before my surgery=2C I was diagnosed with PCOS=2C but had two succes=
sful pregnancies and breastfed both of my girls with no problems. They wer=
e born in 1996 and 2000 I had no problems with my pregnancy with Molly. Sh=
e was born 4-8-2008 and was 7# 13oz at birth. At day 8=2C she was 7#0oz an=
d the pedi asked that I start supplementing 1/2-1oz after each feeding. I =
was able to supplement with expressed breastmilk most of the time=2C but us=
ed 22 cal formula (per the ped) when I did need to use formula. I began ta=
king More Milk Special Blend and Domperidone 3 tabs=2C both 3 times/day. S=
he slowly gained weight. At 7 weeks=2C the ped told me she had mild reflux=
because she was coughing and gagging in her sleep. She told me to feed he=
r 2-3 bottles per day of Enfamil AR=2C and that would help. SHe also said =
to give her Mylicon as she needed it=2C since she has excessive and explosi=
ve gas. She was 8#12oz at that visit. We went to MI on vacation and she wa=
s getting increasingly fussy and inconsolable. I took her to the old ped w=
e took our two older girls to. They started her on Zantac. At that time=
=2C she was 9#10oz=2C 10 weeks old. We were supplementing more with formul=
a at that time=2C because she was so fussy I thought that she was hungry. =
The ped told us that she was eating for comfort=2C since the erosions in th=
e esophagus would be comforted by the food. He told us to let her eat as m=
uch as she wanted until we got the reflux under control. The Zantac was ma=
king her spit up=2C so a week later we took her back and saw a different pe=
d. At that point=2C 11 weeks=2C Molly was 10#8oz. She had gained almost a=
pound in a week. The ped told us we were overfeeding her. She changed Mo=
lly to Prevacid=2C told me to breastfeed as much as possible and only suppl=
ement with 2oz if she needed a top-off. They felt that her gas and fussine=
ss was due to the reflux and that there would be no problem with me breastf=
eeding her. Molly was seen on 7-2=2C at 12 wks 1 day and was 10#4oz at her =
regular ped office. She increased her Prevacid by 1/2 tab=2C and told me t=
o use Nutramigen when I supplemented. Molly was still getting fussier at t=
his point. This last week was horrible=2C with her crying almost all the t=
ime. The ped told me she was worried and wanted Molly to see a pediatric g=
astroenterologist because of possible allergy. She was seen by the special=
ist 7-3. The specialist had an Upper GI done that showed significantly dela=
yed gastric emptying time and severe reflux. She advised that this long we=
ekend=2C I do not breastfeed and only give Molly Nutramigen=2C made to 24 c=
alories. She wanted to experiment. After 1-2 days if she was not better=
=2C I was to add Oatmeal to her formula. If after that=2C she did not impr=
ove=2C we were to start her on Elecare formula. She has done fine on the N=
utramigen alone. She is now on a different dose of Prevacid=2C Gaviscon=2C=
Mylicon=2C and they are wanting to add Reglan for the motility. The GI sa=
id that since my surgery has affected my absorption=2C my milk is most like=
ly too low in calories and fat=2C so therefore Molly is only getting the eq=
uivalent of foremilk=2C which is partially to blame for the gas and lack of=
weight gain. She also said that even though I am being careful with what =
I eat=2C there is obviously something that is offending her. Without direc=
tly saying it=2C she told me to quit breastfeeding- she said I could donate=
my milk to a bank. I do have to admit=2C Molly has done much better on al=
l of the meds and on the formula. So=2C I am pumping to maintain my milk=2C=
as I am not yet willing to give it up. I am heartbroken=2C since I was ho=
ping to nurse until Molly was at least 2. I have been trying so hard to ma=
intain supply and increase the quality of my milk- diet=2C supplements=2C h=
erbs. I was going to ask on Monday if I could at least give her my milk in=
her cereal=2C since I have a good stash built up=2C and at least she will =
still get some benefit. Plus=2C I'll feel better about it. Thanks for any =
help. I'll be on call on Monday=2C so I'll stop in and see what info you c=
an find out. Please call me anytime if you get any suggestions. Thanks ag=
ain. Michell=
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End of LACTNET Digest - 6 Jul 2008 (#2008-746)
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