Please enlighten me as I am new to lactnet, what is RPS?
Thanks,
Suzanne Franklin
>>> [log in to unmask] 07/19/04 9:42 PM >>>
I just wanted to give everyone an update on my mom with severe
engorgement
followed by low supply. Several of you replied directly to me and I
will be
responding to those individual emails in the morning.
I saw the mom again Sunday afternoon and the engorgement had subsided.
Mom
still felt firm (but I don't know how firm her breasts were prior to the
engorgement - mom states they were pretty firm due to the implants) but
I
could feel what felt to be a plugged duct under the left arm (not quite
all
the way back into the armpit). I showed the mom the SNS and she was
willing
to try it. We got the baby latched on the right breast but she did not
want
to suck until I squeezed the SNS enough to make the milk start flowing,
then
she nursed for about 5 min off and on before falling asleep. There was
no
noticeable change to the breast. We were able to rouse the baby and mom
wanted to try the left breast. Baby latched and began sucking, drawing
the
formula into the tube without any assistance. She nursed really well
and
took approximately 1.5oz of formula from the SNS. Mom's breast was
noticeably softer, appeared less full and the "plugged duct" under the
arm
was gone. Mom felt very encouraged but was till not trusting that she
had
any milk, due to her response to the pump. I assured her that her
breast
would not look and feel softer if the baby had not removed milk from her
breast (I really, really wish I had a Baby Weigh scale with me. My scale
is
accurate to the oz, but not 1/2oz .) We talked about having her use the
SNS
at every feeding to allow the baby to increase her supply and not
pumping
for the next day or so as I really feel that this mom is just not
responding
to the pump well and it was eroding her confidence, I believe she has
more
milk than she is able to extract with the pump). In addition, I don't
think the mom really has full nipple sensation, although she says she
"has
feeling in them". The baby was not latched optimally on the right
breast
and when she pulled off, the nipple was slightly pinced and was a little
abraded from moms previous attempts at latching. Mom reported that she
felt
no pain during latch or when touching the abraded area. The mom felt
comfortable with the plan and we practiced with the SNS so that she
would
feel comfortable with it on her own. I left mom feeling with the SNS and
planning to feed every feeding at the breast.
I was unable to reach the mom for follow-up until 3pm today. She told
me
then that she had been to the pediatrician for baby's one week check up.
Baby had gained 2oz in the 3 days since the last check-up and was alert
and
bili levels were falling. When the mom described her breastfeeding
experience to the pediatrician, the pedi advised her to just bottle feed
formula because "it is importnat to know exactly how much this baby is
taking in due to her poor weight gain". The mom said that the
pediatrician
didn't think her milk had come in and that it probably never would if it
hadn't by now. Mom decided to take the pediatricians advice and move to
formula feeding via bottle. Needless to say, I was pretty discouraged.
I
did talk to the mom about continuing with the feedings via the SNS and
giving her supply a chance to rebound, as well as getting the bonding
experience of breastfeeding, but the mom felt that it was too
complicated
and that she had invested enough time in trying and was comfortable with
her
decision to stop breastfeeding. I discussed weaning strategies with her
and
advised her to call me if she became uncomfortably engorged again. I'm
not
sure what I could have done differently, but I sure learned alot from
this
case (and am willing to learn more if anyone else has any input.) Thank
you
all for being willing to offer information and ideas.
Mellanie Sheppard
Arlington, TX
6 days and counting down!
p.s. several of you mentioned using RPS during the engorgement. I
forgot
to mention it in my original post, but that was what initially got the
milk
flowing enough so that we could begin relieving the engorgement. That
was
one of the first gems I learned when I joined Lactnet almost 2 years
ago.
:-)
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