I THINK YOU DID THE BEST YOU COULD DO FOR HER. SHE WAS NOT WELL SUPPORTED FROM THE START, DESPITE THAT SHE'S STILL OFFERING THE BREAST. I WOULD HAVE HER START W/ SKIN TO SKIN IN A SLING. SHE NEEDS A SISTERHOOD LIKE LA LECHE LEAGUE, OR HER LOCAL BREASTFEEDING COALITION. SHE REALLY NEEDS SOME SUPPORT. IF SHE IS STILL USING NURSING AIDES THEN SHE NEEDS SOME CLOSE FOLLOW UP WITH THE HOW TO HAVE ALL FEEDS AT THE BREAST WITH SNS TO MAKE SURE MILK OR ANY KIND IS TRANSFERRING. IS THERE A FREE BREASTFEEDING CLINIC THAT SHE CAN ATTEND TO ONCE OR TWICE A WEEK THAT SHE CAN HAVE THE BABIES WEIGHED AND FEEDING ASSESSMENTS DONE ON THE TWINS. I THINK HER BIGGEST ROAD BLOCK IS LACK OF SUPPORT. IF SHE HAD 1 OR 2 CHEERLEADERS THEN THE BREASTFEEDING PROBLEMS WOULDN'T SEEM SO BIG TO HER.
--- On Thu, 7/30/09, Kirsten Berggren <[log in to unmask]> wrote:
From: Kirsten Berggren <[log in to unmask]>
Subject: Tough case, telling a mom it won't work
To: [log in to unmask]
Date: Thursday, July 30, 2009, 9:21 AM
Hi all,
I had a tough case yesterday - a mom of twins born at 32 weeks, now adjusted age 5 days. Babies in NICU for 2 weeks with only 2x/day contact w mom. Most mom ever pumped (pumping 8x/day) was 6oz in the whole day. Babies now refusing breast (have only ever fed with shield), mom pumping 4-6x/day w total output 3-5oz/day. I asked her what her goals were, and she said she'd like the 3am feeding to be at the breast, not having to get up and deal with bottles in the middle of the night. Currently babies are getting 80ccs formula every 3-4 hours. Mom moved to the area 2 weeks ago, husband travels 4 days/week for work, her mom is here helping, but she just doesn't have enough help or support. Ideal plan would be to get babies to breast with SNS, mom pumping more, doing skin-to-skin - but she's overwhelmed. Worked with one baby yesterday to feed at breast, had some success with feeding tube under nipple shield - but feed was very slow and leaky.
Mom is going to try this week to do one or two feedings per day per baby at breast with tube, keep pumping, and do the remaining feeds with bottles. I see her again in one week.
Honestly, I feel like with her current resources, any more than this is too much to ask. Her postpartum care did not support breastfeeding adequately, she never has established a milk supply. I'm not sure how to tell her that her goal is not achievable with her current efforts and resources. She is already on Reglan as well. She just never got the right information about what it would take to make breastfeeding these babies realistic and has been limping along for 8 weeks.
I don't need info on treatment plans for her, these I can figure out. But any ideas about how to have a frank discussion with her about the likelihood of any real breastfeeding with these babies would be appreciated.
The goal for right now is to get the babies a few positive experiences at the breast with the feeding tube, and go from there.
Thanks,
Kirsten Berggren, PhD, RN, IBCLC
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