Dear ladies,
I searched the archives and didn't find a step-by-step for my problem so I
beg to pick your brains.
Last night I was called to a client. 1st Baby, small for gestational age,
induced at 38 weeks, born 3.400 kilo. Mother had history of miscarriage.
Mother is on medication for hypothyroid, ELTROXIN (thyroxin sodium) 50 mg,
600mg/week. No other health problems.
She took pitocin at the birth.
Breasts did grow during pregnancy but not sure they've seen changes since birth.
I saw the baby at 2.5 days. She'd had a bottle of formula at 5 PM; I saw her
a 9 PM.
No obvious tongue tie but she (the baby) moves it a lot while sucking, so I
thought possible anterior but didn't say anything, yet.
Mother has medium size, soft, almost pointing down breasts, but not tubular
and not widely spaced. Area around nipple, in particular, very soft, nipples
not-exactly-flat, if you know what I mean.
Baby cried at the breast, at first. Mom stripped down and so did baby, did
skin to skin and neonate crawl. Wasn't magic but was better. Mother was
willing but inexperienced and needed much guidence in on how to hold baby.
Anyway, she finally latched on but there was no swallowing. I stayed quite a
while and by the time I left the latch was much more vigorous but still no
swallow.
I was concerned about those soft breasts; where is the milk? But appearances
can be deceiving and why not give it a day?
I left the following instructions:
As much time as possible in bed with skin contact. Baby must have food so
feed with spoon or dropper if there aren't enough wet/full diapers. Express
every three hours with pump or hand (I showed her how)
She had a Medela pump but there was only one flange and it didn't look the
right size.
I heard from the grandmother this afternoon. Not going well, at all, baby
does latch like last night but there doesn't seem to be any milk. Nothing
from pumping, only drops from hand expression. Mother and baby crying a lot.
So, I said: Mother must sleep for 6 hours. Baby must eat every three hours
no matter how, what ever way stops everyone from crying. Start on fenugreek
(they had it in the house) 1 tsp/3 x a day. keep pumping. (get a new flange)
See Dr. Re possible tongue tie. Keep up skin to skin and sucking whenever
baby is willing. Dig up hospital blood tests and see about thyroid levels.
Sunday reassess.
I tried to send them to an IBLC but they don't want.
What have I left out? Is this a place for domperidon (I hope I spelled that
right)?
looking forward to hearing from you,
Yael Edelstein
***********************************************
Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome
|
