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Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 17 Sep 2007 09:01:35 +0100
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>Hello all!
>     I hope someone can assist me with this situation. I have a 26 yr 
>old client
>who just birthed her first baby 5 1/2 days ago today. She has a nice
>aggressive baby and symetrical average sized breasts with NON flat nipples.


Not sure what you mean by 'aggressive' - I am assuming you mean 'keen 
and enthusiastic to feed', is that right?

>She had a spontaneous labor that was sl. long in length and did include an
>epidural and pitocin after delivery. In the hospital she was doing great- good
>latch, suck, no audible swallowing but baby did maintain her wt and was
>stooling and voiding appropriately. She called me the day after her discharge
>with concerns that the baby was "starving". She was crying almost nonstop
>and had only had 1 void since 4am that morning (no stool since then also).
>Upon my assessment in her home, the baby had another void for me but was
>rooting like crazy. Mom's breasts did not feel full in the least 
>(this would have
>been day 3 1/2 after delivery).


It may be her milk had not 'come in' at that point - this can happen, 
and while it's more usual for milk to come in 2-4 days postpartum, 
3.5 days is still within normal limits. Some mothers' milk takes 
longer.

>
>     I immediately turned the tv off, put on music, dimmed the lights, calmed
>the baby, etc.etc. and then helped her put baby to breast. I witnessed a
>similar sight as I had in the hospital- aggressive baby (once calmed down a
>bit) with a deep latch and nice suck (on a finger, pacifier or 
>breast). Maybe 1
>or 2 soft swallows within the 10 min feed. We even relatched a couple of
>times to double check placement. Her suck never really changed to look like a
>let down suck/swallow. After the feed I could get a drop or two with manual
>expression but that was it. (I had already had mom take a warm shower and
>massage before my arrival). The same scenario played out with the opposite
>breast except the infant got very upset only 8 minutes into the feed. Her
>mouth appeared somewhat dry after the feed and her cry sounded sl. hoarse.
>(Pumping with a double electric pump for 10 minutes only gave us a couple
>drops as well.) Obviously there was no change with the breasts after our
>attempted feed and pump.


I can't tell from this description if there is an issue here or not - 
it doesn't sound like  a great feed, I agree, but was there really 
only 1 or 2 swallows in 10 minutes? The lack of milk on manual 
expression could be normal - would it not be better for the mother to 
express, so she could feel where the 'sweet spots' were?  - in 
someone whose milk had not come in and whose baby had just fed.

>      I do not like to supplement with formula but since we had no colostrum or
>milk... we did not have a lot of choices. We dribbled soy formula down mom's
>breast and the baby readily sucked it up.


Is there a reason for the preference for soy formula? There may be 
different guidance in the US, but in the UK it is not advised to be 
used under any circumstances unless there is proved cows milk 
allergy.  But we may be alone in this.

I am not sure why supplementing was necessary at this stage.  Did the 
baby seem unwell or dehydrated? Had the baby lost a great amount of 
weight (might be very useful to weigh the baby now to get a fuller 
picture)?  An hour or two with the baby skin to skin with the mother, 
in bed, or even a whole afternoon like this, can turn difficult 
situations around and give the biology time  to work :)

A less interventionist approach would mean no pumping or hand 
expression, no supplementing, and just a careful watch and wait, 
probably by phone as you probably did....trusting that the 
physiological process would happen.  I think it can be unhelpful to 
guage milk production by what is obtained with pumping.
>  I
>considered maybe asking her Dr to do some prolactin levels too.

We have discussed this before on Lactnet - should be in the archives. 
As I remember testing prolactin levels is of no help.

 From what you say, Jacqulyn, this sounds a very slightly slow to 
start breastfeeding relationship, and all the pumping, syringe 
feeding, supplementing and measuring could be interfering with the 
calm 'togetherness' that helps  support breastfeeding. The baby's not 
ill or dehydrated, so there is a window to permit patience and 
closeness as far as I can see, especially as you are in constant 
close touch with the mother, which means she has a good source of 
support (so important).

Heather Welford  Neil

NCT bfc, tutor, UK

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