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Subject:
From:
Rachel Myr <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Fri, 6 Feb 2004 22:23:27 +0100
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I once had an experience with a family in which there were several potential
problems for supply, one of them being baby's stay in NICU for antibiotic
treatment for the first 6 days.  Our NICU has special guidelines for
nutrient intake for babies on antibiotics and that meant this baby was being
given supplemental feeds comprising about half her intake.  There were
maternal supply issues as well.
We planned follow-up for a couple of days after discharge.  Baby was nearly
at birth weight and no one had any real idea how much she was getting at the
breast, but she was vigorous, eager to nurse and quite content as long as
she was allowed to do so.  I emphasized the need to let the breasts find out
how much food this baby needed, as they had been lulled into false
complacency by all the supplementing.  I spelled out that this meant letting
baby feed ad lib, and using supplements in small amounts at parental
discretion if feeling overwhelmed and needing a break from BF when baby felt
quite the opposite.
On their own they decided to try getting baby into a 3-hourly feeding
routine, as a survival tactic for themselves those first few days at home.
This involved using a pacifier and trying, mostly unsuccessfully, to comfort
baby by other means than feeding until the appointed time had come.  Baby
had lost 4 ounces in the 3 days since discharge when they came back.  They
felt pretty terrible about it when we put her on the scales.  What could I
say?  Her weight was still far from crisis level - and that is what I really
pointed out, at the same time pointing out that we did expect her to start
gaining and if she was signaling hunger, it should be responded to as such.
We talked about how much rest and sleep they had gotten with their plan (not
much) and how maybe it would be just as expedient to feed the baby at first
cue, allowing them all to be more content.  I did not berate them for trying
out scheduled feeds; they felt bad enough already without anyone else
rubbing salt in the wound.  I think they left my office feeling like
perfectly adequate new parents, prepared to learn from their experiences and
committed to making BF work - even though it was turning out to be more work
than anticipated.  They also know I am with them for the duration.  As long
as they need support, they can get in touch.  If they had felt that I judged
them and found them wanting, I don't think it would improve the chances of
the baby being breastfed, and that's the overriding goal for me, always.
It's hard when you see a mother suffering needlessly because she has always
managed to suffer through initial soreness and believes it has to be that
way.  When she refuses an offer of help with positioning and latchc, and
tells me 'it is like this with each baby, and it passes, I just need to get
through it' I am not worried so much as puzzled, but maybe it has to do with
empowerment.  Maybe she needs to be able to rely on her own determination
rather than advice from yet another staff person who thinks she knows best.
Rachel Myr
Kristiansand, Norway, where women frequently have 3 or 4 children by age 30,
and can manage to get through 4 post partum stays without learning painless,
effective latch

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