I have been a consultant for one of our Public Health Nurses who has been
supporting a family whose baby was born with multiple abnormalities
(neurological and gastrointestinal - leading to GI surgery).
Mom's milk supply has never been abundant, and once the baby was discharged
into her care the production did not increase. Various pumps, equipment,
etc. were tried and she was also started on Reglan.
When I finally saw them there was little I could do that had not already
been tried by other LC's. Weight gain was minimal, I evaluated various
feedings and did not see (weight checks prior and after feeds with
sensitive scale) adequate milk transfer. I also observed pumping with
various kits and saw less than 1 oz removal in 15 minutes of pumping and
massage. Mom was pumping every 2 hours and was exhausted and
panic-stricken as the milk she had frozen during the baby's hospitalization
was quickly being used. As the family was adamant about not giving this
fragile child formula, arrangements were made to get milk from the San Jose
Milk Bank. (By the way, this family DID get Signa to pay for the breast
milk which I believe is a first in our area.)
The reason I am posting to Lactnet on this case was their report - we had
discussed that mom was getting depressed (she had a history of depression
prior to the pregnancy), and as we were seeing little results in milk
production with the Reglan, I suggested she stop it. They reported that a
few days after she stopped it, the baby had more vomiting and
gastrointestinal problems after consuming the milk from the milk bank. Baby
was still being breastfed, then supplemented with banked milk. As they
could think of nothing that had changed besides the Reglan, mom resumed
taking the Reglan and the symptoms disappeared.
Baby is currently gaining well, mostly on milk from the milk bank, but
breastfeeding prior to feeds when mom is home (she is the primary
breadwinner and had to return to work to keep her insurance).
I have always considered it important for moms to put their babies to
breast even if they don't have full milk supply, mostly thinking of the
bonding and the live cells that would help protect the baby from illnesses
in their environment. In this case, it appears her milk is also medicating
the baby at the right level to maintain better health. (Yes, I realize
that this would need to be tested by asking mom to stop the Reglan again -
but could you? ...and would that really be a test as the baby would be at
another stage?)
Just a thought for those of you working with these very sick babies.
Jeanette Panchula, BSW, RN, PHN, IBCLC
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