Hello Lactnetters,

I have just started working with a new mom and would like to post some
info. about this case and get some comments and suggestions.I have many
thoughts swirling around in my head and need to get some perspective!
Received a call yesterday from a mom of an 8 day old newborn girl.Birth
weight 7 lb. 8 oz.  Her first comment was that she has a "low milk
supply."
She said her "milk never came in". Baby delivered at a hospital, on day
4 a visiting nurse sent by U.S.Healthcare( health maintenance org., I
think) came to do a post part. visit . apparently, nurse became alarmed
and called ped. for several reasons( this from the mom, remember): baby
was "jaundiced", baby weighed 6 lb. 13 0z. -may have been a few oz.
less, mom can't remember-, and baby had not had any urine or bowel
output for 24 hours. Mom said ped. told her to put baby on formula,
which she did. (baby did pass meconium, as per mom).
Mom said she has sometimes tried to pump with a manual pump and gets
very little, at most a teaspoon.(I am going to give various bits of
info. in no part. order, maybe even typing it in will help organize it
in my thoughts- my notes are a mess!)My antennae went up when she
mentioned that her milk never came up- I asked about breast changes:
during preg., breasts got a little bigger, sore, nipples and areola
darkened, veins became prominent-sounds like pretty normal prenatal
breast changes. However, she said she has not noticed any breast changes
since the birth (altho her nipples got sore from nursing).
Mom said no breast implants, no reduction, no breast surgery- did have
benign lump -doc. used needle to draw out fluid , which showed it to be
benign,but it does not sound like surgical removal.She said she has
fibrocystic breasts.
How can this affect milk supply, if at all??

Labor and delivery: vag. birth, no excessive post part. bleeding, water
broke first, after 24 hours she was induced with pit. and given IV
antibiotics.
She said baby is not nipple confused, will go to breast altho she was
given formula in bottle.
I calculated weight loss from birth to day 4 as about 9.2 %, which my
understanding is within acceptable parameters.
Mom had called the local Allegheny County Breastfeeding Helpline
(something like that- I must confess I am not familiar with this, having
lived here only 8 months.)She was told about a study at Children's Hosp.
- a study of moms with low Milk Supply, where moms are given Reglan for
10 days-that's all I know about said study. I advised her that even if
one is taking Reglan, it increases MS only while on the meds., once you
go off it the MS decreases again. Sounds like she was not interested in
this study- she does not want to take any meds. Anyway, she actually did
go the said Hospital to see about this study, and ended up being given
an SNS by an R.N. there-I asked if this woman is an LC- info. the mom
had implies she is not- she is an R.N. in "clinical research". Anyway,
apparently this nurse got mom started using the SNS with formula, at
least an improvement over the bottle. So mom has been using SNS since
day before yesterday.

I told mom we need to figure out what is cause of "low MS"- if indeed
she does have a low milk supply. But first, we need to keep baby fed and
gaining weight. Told her to keep using SNS with formula, nurse every 2
hours aroung the clock, (allowing for one longer stretch), she said baby
has no prob. latching on despite use of bottle, ; strongly suggested she
rent electric pump and double pump after feeds to try to increase MS,
observe baby's output and told her number of poops and wet diapers to
look for; told her to get lots of rest, eat well, etc.-focus on feeding
baby and recovering from childbirth and leave everything else to husband
and her mother, who is visiting(she did mention her husband and her mom
do not get along and there is some stress due to that); advised her to
tell ped. that she is using SNS and that she should have ped. do a
weight check on the baby at least once a week (baby doesn't really sound
in critical condition-don't think FTT is going on here-sounds like real
prob. is getting mom's MS back up and figuring out what caused it to be
low).Actually, if baby was getting bottles of formula from day 4 to day
7, and mom was only doing occasional pumping with manual pump, there
wasn't much breast stimulation to speak of, so of course she would have
a decrease in MS- the thing that worries me is that she said her milk
never came in- she did not experience any engorgment-well, I know we
don't consider engorgement "normal and necessary", but it sounds like
she didn't notice any change at all.
Why did baby have no dirty or wet diapers for that 24 hour period-that
would have been about day 3 of baby's life. . . is that ok (I don't
think so?) . . .
I know I still need to look into the areas of positioning, maybe baby
latched on readily but wasn't latched on correctly, so she wasn't
getting much. . . or maybe there is a prob. with the baby. . .
tongue-tie. . . etc.

I feel baby will be ok for time-being, if mom just keeps using the SNS
and getting formula in baby that way. . . and breastfeeding relationship
is being maintained in some fashion that way. . . gives mom some breast
stim. . .  and hopefully by now mom has gotten electic pump and is using
that. . .

Am I worrying too much here. . . is this a "simple" case of baby being
put on bottles due to visiting nurse's and ped.'s ignorance. . . and so
we simply work at building supply back up and eventually getting rid of
SNS. . . or is something going on here that is not so simple. . . I
really feel like this mom needs a home visit. . . only problem is that
would be a monumental challenge to arrange (I have 3 young children. . .
as I dash this off I am about to go to a parent-teacher conference).

Please post any comments, thoughts, suggestions, helpful ideas, etc. I
have this feeling that the breastfeeding could be lost if I don't keep
us with this mom, BTW she is a first-time mom.

TIA, Ellen Vegh, LLLL, Pittsburgh, PA