I don't know if the whole issue is the mag sulfate or the edema from the
hypertension, or the hypertension itself. But these women are not having a
normal experience, and they don't feel well. I have many times observed
delays in lactogenesis -- some as long as 10-14 days. So this is often one
of those unfortunate times when I do reach for formula. I simply explain
that mom needs to keep stimulating with pump, and baby if baby can help.
She just has to wait and the problem will go away.
An article several yrs ago in Peds in Review discusses that mag sulfate can
have an effect on the INFANT, creating transient hypotonia, which possibly
will affect feeding ability -- potentially altering early breast stimulation
& decreasing infant's ability to feed. So I red flag the babies and think
they need a bit closer monitoring if mom has had magnesium sulfate. After
the intake visit I stay in pretty close ph. contact with the mom, querying
about how her swelling is doing, reassuring her that this will all resolve
and that it won't be hard to transition baby. She can feed the baby formula
in the meantime however she wants to, altho I cont. to be cautious about
suggesting cups with floppy babies. Baby needs skin-to-skin time, and
practice sessions at breast even if not much happens. When everyone is
recovered, I go back and help mom latch baby. All the pumping in the
meantime has generally everted her nipples, and if not, I use a shield until
baby gets the idea that if you suck, milk comes out!
The older I get, the move convinced I am that such situations should be
treated quite matter of factly, with no excitement. Sort of like: " Oh
these things happen. What a pain, but no big deal in the long run." The
moms are so sensitive to negative suggestions, but on the other hand, I
think they are real receptive to positive suggestion. So I always plant
suggestions that everything will be ok.
Barbara Wilson-Clay BSEd., IBCLC
Private Practice, Austin Texas
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