Hi everyone,
I am a newly-minted IBCLC (after 6 yrs as a La Leche League Leader) and
long-time lurker on this listserv. This is the first time I have posted.
I am working with a mom who is due in April with a baby that has been
diagnosed with gastroschisis; this is a fetal defect where the baby's bowels
are floating in the amniotic fluid outside of it's body. Needless to say,
this mom is facing a difficult first few weeks/months of her baby's life.
Mom has been told by her OB that she needs to find out as much as possible
about breastfeeding, because breastmilk will be her baby's best medicine.
I have been reading on the condition and it seems as though most of these
cases involve baby in the NICU for a long time (12 wks+), initial feedings
via IV, then NG/OG tubes with breastmilk or formula.
One major complication to all this is that the mom had a breast
reduction/lift (including an implant) with periareola incisions. If you are
thinking "YIKES!", that's exactly how I feel!
I need your wisdom and experience to help this mom!
The course of actions for both these situations, gastroschisis and
breastfeeding after reduction, depend greatly on what happens at/after the
birth. Doc has told mom that they must wait and see how bad it is (could be
only small intestines out, or both small and large, part/all of the liver
too, etc.) before having a clear understanding of what to expect. Surgery
immediately after birth (within a few hours, I believe) is a given, as are
the long weeks in NICU. But the feeding situation will depend on many
factors: how the baby is recuperating, how the baby responds to the food,
whether jaundice becomes a complication, etc.). As for BFAR, this is a
challenge I would normally approach with a "wait until the baby is here and
you begin breastfeeding then monitor closely to see if any supply issues
become evident". B/c this baby will likely not be put to breast for a LONG
time, I know I will be focusing on getting pumping going as best as possible
from the beginning.
So far, everything seems to support a gain knowledge, prepare and wait and
see approach, except for this: mom reports that she is soaking breastpads
with colustrum!
1. I've heard of pg moms leaking some colustrum, but is it within normal
that she would be "soaking" pads? And if not, woah!, maybe it is something
bad, like a leaky implant or puss, etc...
2. If it IS colostrum, should I encourage her to start collecting and
storing it? My thinking is, if it's there, why not? It will stimulate her
breasts, get her very familiar with pumping and she'll have "insurance" for
feeding the baby as soon as possible with her milk.
3. Could pumping starting so early (she's close to 7 months along, I
believe) hurt her/the baby/her production in some way? This might be a dumb
question, but can her body make mature milk before the baby is born if she
pumps regularly during the last months of her pregnancy?
As you can see, I have many, many questions! I would appreciate any and all
suggestions.
Sorry this message is so long--it's a long story to tell...
Thanks so much for your time,
Ana Estorino Uribasterra, IBCLC, RLC
South Florida
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