Hi all. Would like to know how others handle this situation.
Mother I hadn't seen before returned to postnatal ward for baby weight
check as baby had lost >10% before discharge (Day 3).  Baby now 12 days old
and gained weight (60g - 2oz) in previous 3 days. Paeds were happy -
goodbye.  Not me!
It's mothers second baby and she reports 'gallons' of milk for weeks and
weeks with first baby. Reports milk 'kind of' came in with this one -
didn't really notice much difference.  What's the PV bleeding like? - yeah
it's still bright red and getting fingernail size clots sometimes. Warning
bells flashing for me.
I watched her feed - latch wasn't good, so we worked on that (granted, this
might make a big difference).
I wanted her investigated for retained products of conception (RPOC). Paeds
not interested naturally, obs questioned her and examined her then wrote
her up for antibiotics - which is their routine management.  I begged them
to do an ultrasound, telling them the milk supply could be completely
stuffed up if there were some RPOC - no go.  they said that because she is
bleeding still the u/s will sound up blood clot which they can't
differentiate from placenta, then they would be obliged to do a D&C.
What are your comments and opinions?
Also they (paeds) had started her on metoclopramide (Reglan) - 10mg TID for
10 days then cease.  I said no 10mg TID 5 days, 10mg BD 5 days, 10mg daily
5 days - that is our usual routine (yes, it is a 'usual' treatment for poor
infant weight gain - don't get me started).  Anyway the paed said that the
tapering dose hasn't shown to be any more beneficial than the full dose as
prescribed. What do others do? Have you seen this written - ie researched,
anywhere?
Denise

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Denise Fisher, BN, RM, IBCLC
BreastEd Online Lactation Studies Course
http://www.breasted.com.au
mailto:[log in to unmask]
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