In a great LLLI LC workshop, Nancy Hurst of Texas Children's Hospital
talked about "The Disrupted Dyad," and how to enhance the fragile
relationship during prolonged hospitalization. (There was a recent
thread about NICU support -- this person would be an excellent resource
--their NICU families had a newsletter and other programs in place).
Perhaps the mother that Jennifer describes is having trouble letting
down milk, contributing to the baby's fussiness. Nancy Hurst mentioned
that some very successful long-term pumpers, reunited with the baby, had
trouble letting down milk while breastfeeding -- their response had been
conditioned to a certain stimulus, and it took time to change that. I
found this startling, but if you think about, we see the reverse
situation all the time -- a woman with a thriving baby who has trouble
letting down to the very different stimulation of a pump. It seems like
many women need to find different tricks to help with that transition,
such as having some physical reminder or intense thoughts about the
baby. Maybe Jennifer's patient could try pumping on one side while
nursing, or even just holding the flange to the other breast, or nursing
at the pumping station, to try to use that association to prompt a
let-down while making the switch.
If a baby is temporarily getting supplements, there's a lot of logic
behind the idea discussed several times on Lactnet, for giving them
first in the feeding session. If the supplement is routinely given
afterward, the baby is rewarded for fussing and rejecting the breast by
getting the "real meal." An older baby, with less reflexive and more
controlled sucking, is even more likely to want to cut to the chase.
Plus the mother goes through the breastfeeding session waiting for the
baby to get upset, with questions in her mind of "how long do I prolong
the battle?" and "is that enough breastfeeding?"
If the supplement is given first without a lot of ceremony, with a
slow-flow nipple and paced feeding (as described by Dee Kassing and
others), then the baby can come to the breast feeling good and
energetic, for a dessert and a relaxing session, and the mother can
settle in for lots of skin-contact, breast compression and eye-contact,
knowing that the baby is reasonably happy..
I usually describe to the mother the two approaches to giving the
supplement, and say that she may have to fine-tune things a bit
according to what she's seeing. We don't want to give so much
supplement that the baby conks out quickly -- we still want him or her
to transfer milk at the breast. Once we have the baby doing well on a
certain amount of supplement, we can start cutting back on that. This
is usually combined with some pumping, so the mother can hopefully be
providing more and more of the supplement too.
It's wonderful to read Dr. Tieman's posts..
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