I have a new baby, now 5 days of age (born 9/12/03) at 38 5/7 weeks to
first-time mom. Labor was spontaneous, mom had 1 dose of IV narcotic during
labor, delivery was not instrumented. Birth weight 6 lbs 10 oz (3010 gms.)
Baby latched well, but was noted by mom and nurses in the hospital to have
just brief periods of rapid sucking, then to fall asleep. Baby did have a
circumcision performed with local anesthesia at about 18 hours of age. At
44 hours of age, he was also evaluated by our IBCLC, who reported to me that
the baby roused easily and nursed actively for about 20 mins during her
consult, then fell asleep. Mom could express colostrum, and baby passed
several meconium stools and voided 4 times the day of discharge (at 48
hours.) Discharge weight was 6 lbs 1 oz (2760 gms) After the LC saw him he
had one more feed that mom reported as good, active sucking for 20 mins
prior to discharge, so we thought he was starting to feed well. Mom was
given a follow up appt in 48 hrs and advice on keeping baby awake, lots of
skin to skin, feeding on cue, etc.
I saw him 48 hours later, and mom reported no stools since hospital
discharge, and baby was again falling asleep quickly at the breast. Weight
(now at 4 days) was 5 lbs 12 oz (2615 gms.) Baby was alert, latched well in
the office, but again fell asleep quickly. Mom can express drops of
colostrum, but does not feel her milk has come in, and breasts are soft. He
did not appear jaundiced or dehydrated, but given the weight loss, the
ineffective feeding behaviour, and poor output, we started a plan to
supplement (finger feeding or by cup) continue nursing as baby is willing,
and pump after feeds during the day. Any milk pumped will be used to
supplement.
2 questions: Mom asked me if any galactogogue would be useful in this
situation. She had heard of fenugreek. I'm thinking the problem here is
more baby unable to move much milk, along with perhaps a bit delayed mature
milk supply, so I'm thinking a galactogogue would not help?
Also, there is no convenient pump rental station here (we're hoping to
perhaps start one when we finish a labor and delivery remodel sometime next
year.) This mom only has an Avent Isis hand pump. She is able to get small
amounts of colostrum with it. There is a pump rental station about half an
hour away. Is it important that she get a good double pump for at least the
short term?
Unfortunately this mom does not qualify for WIC so cannot see the IBCLC
again so she has to settle for me! She is very committed to breastfeeding
(in fact commented that she wasn't even going to get the Isis since she was
planning to exclusively breastfeed and is a stay at home mom. She got it as
a gift.)
Jennifer Tieman
Family Physician
Mom to 4, including nursling Caroline Rose born 5/31/03
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