Hi All,
I just feel the need to vent a little.
Yesterday I had parents come for a visit with me who have a 5 month
old who weighs 11#1oz. BW was 8#6oz.
She just changed pediatricians because her previous one was telling
her she needed to supplement. The pedi here in our office that saw her
asked me to do a pre and post wt check with them so that we could have a
more objective view of what is going on. (she told me how they were new
pts to us and why they had left their previous doc)
While asking my questions, I asked if she had seen another lactation
consultant ever, and they stated that they had when their baby was 3 days
old, but it was a "bad" visit and so never saw one again. I asked what
had happened and they told me that the baby hadnt gained any weight yet
and the LC had the mom pump and they didnt get anything out, and so mom
was told to supplement, rent a pump ....
WELL...obviously at 3 days it is normal to not see weight gain, and
not all breasts respond to pumps ... but the info provided by the LC
wasnt bad or incorrect, just not what the mom wanted to hear. (just as a
FYI for all my Austin buds, they were from another town at that time) :-)
SO... I do a pre and post in my office and after 20 minutes on one
breast with no audible swallows, baby took in 2cc! Put to opposite breast
for 5 minutes of nothing audible, mom switches back to first "more
productive breast" , gets a let down, 1:1 swallows x 30 seconds, and baby
pops off done. Took in 18cc! (total 20cc)
YIPES! And now its all on me to present to this mom in the most
delicate manner that she is not producing enough - and in such a way that
we don't also lose her as a patient!
The baby seems to be meeting all her milestones. She
certainly "acts" like a 5 month old, but she looks like a 2 month old.
Dad is small statured (5'5"), mom is (5'9"), and others in family hx are
4'11 etc... Mom breastfeeds 24/7, almost literally!
So, of course, I praised mom for being so available to the baby.
That she is absolutely beautiful and appears perfectly normal mentally and
emotionally. Of concern is how her growth curve is now going down.
Explained how it is alright to have a baby in the 5th percentile as long
as they continue on curve, or go up on curve. They said how they kept
watching her head circumference as they know that famished kids have
larger heads because all the nutrition goes to the head to protect the
brain.
Mom absolutely hasnt wanted to use any formula. She did agree to
trying some in office...which of course the baby didnt want to have
anything to do with. We discussed trying the SNS as the baby loves to
breastfeed, but mom not happy about that and doesnt want to try it. We
discuss the formula that they can get at health food store, we discuss
trying to get some donor milk, we discuss galactagogues.... Of course,
mom only has manual pump. We do some manual expression and get NOTHING !
Poor mom is trying hard not to cry. I touch her leg in empathy and
she starts crying. I re-emphasize what a terrific job she has done up to
this point; how well attached they are; how great it is that they co-sleep
and use the sling ...
Mom leaves office with samples of formula and some fenugreek seed
capsules. (I work in a pediatric office that has samples of formula) I
suggest to them that they mull over all their options through the weekend,
and we will talk on Monday and come up with a plan. They are OK with that
plan and sadly leave my office.
ECK. I hate it when moms dont produce enough milk! I hate having to
be the bearer of bad news. And I also hate how the doctor put it all on
me! Tho I guess I could look at the positive - that the doctor thought I
would be able to present it in such a way that the parents would not feel
threatened.
The only "red" flag she had in possibly not being able to produce a
sufficient supply, was that she experienced very little breast growth
during her pregnancy. So its possible that she doesnt have enough mammary
structure within the breast to produce enough.
I made sure they understood that I was in no way stating that they were
going to have to stop breastfeeding, and that the baby was way too
attached to mom and to breastfeeding for that to be an option, but they
are probably going to have to consider some form of supplementation to the
breastfeeding, unless the fenugreek suddenly increases her supply. I gave
her a handout that discussed all the ways to increase your supply. (from
pumping to all the various herbs to reglan to SNS to breast and bottles...)
Oh well, I've rambled on enough.
Linda
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