rachel, barbara and all
i think we are all beginning to realize that the critical switchover occurs
quite early. what would you recommend in these situations:
mother not yet transferred to postpartum ward, due to high bp and on
magnesium sulfate iv. at our hospital, the peds will not allow bf for 12 to
24 hrs after the mgso4 has been discontinued. (their rationale is baby is
already depressed from antepartum exposure to the med, and don't want to add
more on board via breastmilk. i have shared info on low exposure due to poor
oral bioavailability, aap approved, etc to no avail). would you suggest the
mom begin expressing, having to THROW AWAY THE COLOSTRUM or would you
recommend the mom wait and hopefully soon will be able to directly bf. this
is a real dilemma. moms know their colostrum is valuable and dont' want to
throw it away. often (possibly due to c/s or lots of iv fluids) milk supply
seems delayed, or at least colostrum seems scant or not present at all. so
would it be feasible to wait. i certainly would not wait if the milk was to
be given to baby, or if the mom was getting obvious breast changes, ie
fullness. if a day or so passes, even w/o expressing, how is the milk
changing in the breast?
also, occasionally have a mom who is pretty sick and then it is a fine line
between should she be started expressing, or could she reasonably wait if
she is fairly ill. of course baby needs the ebm, so that is always a factor
too. unless premie baby not on oral feeds yet.
i guess it is a judgement call, please share your thoughts.

Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA


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