I'm gonna weigh in here, bravely, as I think Martha's case (interestingly)
shows up a difference in practice and in outlook between the US and the UK,
and between IBCLCs and lay counsellors. So bear with me!
> Baby was born (to unmedicated mom) at our out of hospital birth center
>4/8/99. Birth wt 8lbs 3 oz. Transferred to local hospital postpartum for
>repair of 4th degree laceration.
Anuthing happen at or around birth (suctioning, unnecessary separation,
extra formula or glucose feeds, rough handling???)? Might explain fussiness
on day 2.
>Phone followup over the weekend
>sounded reassuring, w/ milk coming in, better feedings.
> At next wt check 3 days later (a monday), the baby had lost 5 more ounces,
>and we began pumping 6-8x/day(lactina), and supplementing (ebm as much as
>possible, formula to make up the balance); and fenugreek 3caps TID. Parents
>offered option to supplement with Haberman or SNS, they chose Haberman.
This is the bigest gap between what would be likely to happen. The further
weight loss probably would not have been noted - babies are weighed *much
less frequently* here. So if the baby appeared to be continuing to feed
well, we would have taken no action except to observe and encourage...and
there would have been no intervention.
Even if the weight loss was known about, or if it was thought the bf could
be improved, we would probably just suggest more bf...and as Habermans and
SNS are rarely used by UK mothers (not liked - too fiddly) these would not
be on the scene. Nor would the fenugreek. Pumping might be suggested, but
not at this stage, I don't think....if it was thought enough extra breast
milk could be got into the baby by more skin-to-skin, co-sleeping,
following baby's cues.
> Next day's wt check showed a gain of 4 oz. Parents reported poor success
>with haberman, given SNS, this worked well at breast.
Gain of 4 oz in a day? Why not work at reducing supps?
> 2 days later, baby had gained another 6 oz, and I estimated at that time
>baby was getting about 50% of her total daily intake as breastmilk (pumped
>and direct from mom added together). All supplements at breast w/ SNS. Baby
>latching better, much less fussy, archy.
> This pattern continued for the next two weeks, with mom's milk supply
>eventually getting up to around 2/3 of baby's total intake, at a wt of 8lbs
>8 oz.
That's okay - baby is 2 plus weeks, and 5 oz above birthweight. We'd think
that was okay for weight, and we'd be wanting to be reassured the baby was
feeding well at the breast....and that would be crucial.
We would not be talking about Reglan, or pumping, or SNS....just getting
the bf going well and happily .
> At 5 weeks, wt check showed a gain of only 2 oz in 7 days, mom had
>decreased pumping due to ductal pain. Increased supplement volumes again.
But 2 oz in one week is okay - not wonderful, or reassuring, true. We'd
look again at how to increase bf. We would prob. not inc. supps. We would
look carefully at the way the baby was at the breast, how he attached, and
whether this could be improved in any way, to make feeding effective.
>4 days later mom called me in tears due to pain a/w thrush. We prescribed
>APNO, cont'd Fluconazole, and gentian violet. Also taking Ibuprofen for
>pain.
> Baby had been fairly content and fed well at breast, esp with SNS, up to
>now. Now she is restless, fussy during feeds (probably not thrush, we
>re-treated her a couple more times during mom's long bout with thrush).
Babies do get fussy - no comment on this! Could be the thrush is affecting
comfortable and effective positioning.
> At our most recent visit, around 8 weeks, baby had only gained 8oz in 15
>days. (10 lbs 7 oz). I recomended that she increase her supplement volumes
>again.
But that weight gain is okay according to our norms. We would not be inc.
supps. More important to observe the feeding and encourage the mother.
>During this time mom had been on Reglan (still is, tho tapering off
>now), and pumping an average of 5 times/day, usually 1 hour after
>breastfeedings. Feeds 10-12x a day at breast.
But it doesn't matter how often if the feeds are not effective.... though
my guess would be (on the facts as they are here) is that the baby is
probably feeding okay. Is the mother letting the baby set the pace and
length of the feeds?
The whole daily regime must be hard for the mother - all the fussing with
the pumping and the SNS, and remebering to take the Reglan, and all the
pain and stuff with the thrush...! Phew.
The main difference is that here, we probably would not have intervened in
that first week. And we would be less concerned with what the scales showed.
Any other comments from UK?
Heather Welford Neil
NCT bfc Newcastle upon Tyne UK
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