Oops, I started this and accidentally hit the send button! Sorry to repeat
the beginning of my message and some of Jean's.
Jean, I wish I had some brilliant answer for your question. All I can tell
you is I've been seeing and hearing from more and more MOM experiencing this
same problem. Please tell the mother to keep plugging away. I HAVE seen this
resolve--several times--sometimes suddenly and sometimes slowly over time;
sometimes within a few weeks and sometimes at around 3-4 months. I with I
could figure out why it is occurring. I cannot determine one consistent
"thread." I been asking about health/breast history, fertility, (multiple)
pregnancy complications or related treatments, etc. None comes up with any
consistency, but prolonged and/or strict bed rest during pregnancy seems to
pop up the most. And for many of these MOM, bed rest continues after delivery
due to surgical birth, post-delivery MgSO4 treatment, postpartum hemorrhage
[PPH], etc. Still, I've discussed this with bed rest research guru Judy
Maloni a few times, and the physiologic chages of bed rest don't "fit" either
for a long-term problem with production. (You might find the JHL case study
re: mom of quads useful/reassuring--vol. 14, issue 2, pg. 135-141.)
Retained placental fragments can be a toughy to figure out in MOM, because we
usually bleed more/longer anyway due to amount of area covered by placenta.
PPH is lots more common for MOM. One thought--what is this mother's H&H
history--pre/post delivery?
BTW, her thyroid function could have changed since last checked. Did you see
the recent research report that found a 8-12% incidence of PP thyroiditis?Ya
just know it's gotta be even higher among MOM!
Was prolactin level checked?
How does she scale her level of the "blues"--low or high? (PPD is 2-3x more
common for MOM and can affect breastfeeding/pumping.)
I'd ask specifically about the kind of pump she's using to make sure it's
appropriate for the situation. Any chance there's a mechanical problem with
the pump?
I think the plan to pump at least 8x (at least 100 minutes?)/daytime with
nighttime sleep period of up to 6 hours is a good one for now. I'd suggest
she track pumping sessions on a checklist chart so she can see if she's
pumping as much as it feels that she is. I can't really buy into the theory
that stress or fatigue may have that important of a role in this phenomenon.
If they did, none of us MOM would've had any milk! Except for the 1-2 MOM who
have "perfect" experiences/babies vs. the 1000s who don't, stress and sleep
deprivation are just part of the multiples' pregnancy, birth and
breastfeeding package! If stress and/or fatigue play a role, it's gotta be
related to some sort of physiologic change that affects milk synthesis (once
all else is ruled out).
You didn't mention why you had to actually work to get an order for 31
weekers considered ready for p.o. feeds to be "allowed" to be held
skin-to-skin once (only?!?!)/day? Aren't the clinicians in your area aware of
the research re: incredible physiologic benefits for babies during
skin-to-skin contact?
How about co-bedding for these multiples? They sound like it would be perfect
for them.
Sounds like you are doing a wonderful job. Good-on-you. But don't let it keep
you awake nights. You'll be in better shape to help this and other mothers
and advocate for things like Kangaroo care if you've had a good night's rest!
Again, sorry for the prior preterm post...
Karen Kerkhoff Gromada
In a message dated 08/28/2000 11:22:41 PM Central Daylight Time, Jean
Macomber writes:
<< Help! I have a NICU mom who had triplets via C-section 17 days ago (they
were 30wk + 5 days at delivery) and she cannot produce more than 1/2
ounce of milk per pumping session yet! Many times, it's not that much!
We started her pumping within the first day. She had a history of 3
bouts of preterm labor, coming at 21 wks, 28 wks and 30 wks. She was on
Terbutaline 5mg po q 4 hrs for 10 wks (!) and on Magnesium Sulfate IV
each time she was admitted for preterm labor--the last time for 3 or 4
days prior to delivery. She was strictly on IV fluids; nothing by mouth,
for 48 hrs prior to delivery. (They were trying to hold her off from
delivering, but I think were afraid she might end up with an emergency
C-secton so didn't want food in her stomach.) She states no history of
breast/chest surgery. Did experience breast changes during pregnancy.
Did not make attempts to express colostrum during pregnancy and had no
spontaneous leaking. Denies thyroid and pituitary problems. This was an
in vitro fertilization pregnancy, but she states the reason had to do
with Dad, not her. She states she pumps every 3 hours (I think she has
rental pump), drinks plenty of fluid (her swollen ankles look back to
normal) and gets rest (no other kids at home and she only comes to NICU
twice a day, being driven by a relative). She is using Mother's Milk tea
and fenugreek...
Oh, yes...the babies are doing well for their age. In isolettes, attempt
po feeds twice a day and I was able to get an order today for parents to
hold skin to skin once a day. Mild spitting, rare bradycardia episodes,
most of which are self-correcting. Cute as buttons; one boy, two girls. :^)
>>
Thanks in advance. This one's keeping me awake at night! >>
***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html
|
