Thank you all for your input. I hope I can answer all the questions. Karen,
the mother is calling me, with me returning missed calls at this point. I
did try to call her, and left messages when she was staying at the
relatives house, then since then she has called me. (As a rule I will call
a mother twice, if I don't get a response I figure she probably isn't
interested in what I have to offer.)
Her nipples seem a litte irritated, but she is not in pain. I am chalking
it up to letting him nipple feed and that tongue. I think fixing the nipple
feeding will remedy this.
Wow, I didn't know the word "compliant" was such a hot button, I have
certainly seen it on Lactnet before. It is commonly used in charting. It
seemed more expedient than saying "we agreed on a plan of action, she said
it would work for her, and then she didn't do much of it, and is still in
disress, and asking for more help." I am sorry if anyone was offended.
I saw her this afternoon.
We undressed the baby for the weigh, and he was as chubby as could be. He
is still gaining 10 oz a week! I gently suggested that she could really
afford to start weaning him off of the formula, and he might continue with
supps just from the milk she was pumping (I saw her chart on the table, she
is getting, on average, between 3.5 and 1.5 oz per. Not as bad as she had
related.) He aslo had a really wet diaper. I had to stress that "feeling
empty" isn't a problem at 6 weeks post partum. She seemed to be comforted
by engorement. "I know there is something there." We talked about the fact
that there IS "something there" even without the discomfort of engorement.
I asked the mom what SHE wanted to do, what she wanted from me, and that
she needed to let me know when I was maybe being too, um, assertive, and
she needed to call the shots and let me know what she really wanted from
the breastfeeding. I stressed that this was her baby and her breast. (I
really have no problem being direct. LOL)
After an OK feeding, (about 15 min on one side and about 5 on the other,
with baby self detaching, sleepy) the baby had transfered 2 oz. We had to
reattach the baby at least 5 times on the second side, as he kept sliding
towards the end of the nipple. THIS could be a big part of the problem. I
stressed they would both be better off if he was taken off and reattached
EVERY time he did this, rather than just letting him nurse while not
compressing sinuses. The swallowing seemed better, and MER occured faster
than the last time I saw her, but he had been nursed shortly before I
arrived, so I can't go on ONE test weigh. She decided (I am so glad she
made the decision!) that she did NOT want the shield, as she understood
there was a possibility that it could compromise her supply. We got her set
up with an SNS, and she and the baby did wonderfully. (He saw the SNS and
thought it was a bottle and started vocalizing at it, like he does towards
*her* when she is opening her shirt.) He took a little less than 1.5 in the
SNS and still gained an *addition* ounce from her breast. For a 4.5 ounce
feed in all.
He was in arms more, and she seemed to be responding to earlier hunger cues
than 2.5 weeks ago.
We talked about "sucky" babies who need to snack all the time. She related
the idea to her dh, who shrugged and said "So what, I eat about 10 times a
day, too!" I said, "See, it's genetic." and we all had a good laugh. I am
hoping this time the idea that *some* babies need to nurse quite a bit,
even if they aren't ravenously hungry, and it does NOT mean they are
starving to death, sunk in. This baby LOVES to suck. (I am SO glad she is
totally against pacifier use, I can't even imagine the trouble we would
have if that were the situation.)
She seemed more relaxed. I hope she continues to work at this.
Thank you all again. It is much appreciated. It is really helpful to air
the entire thing out to others in the field, especially with a "high need"
client. Only you Wise Ones understand.
Mary Jozwiak IBCLC, RLC, LLLL, AAPL
Private Practice
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