I just had a final follow-up with a mother which I would like to share.
Please excuse the vagueness of some of the details as I don't have the
records at my home and am reconstructing it from memory.
Mother underwent a reductive mammoplasty in 1992 and was told that the goal
of the surgical technique was to allow her breast to function normally,
though she doesn't have details about what was actually done.  She has what
seems to be normal sensation in her nipples but they do not become erect on
stimulation.  There are scars all around both areolae and she reports that
about 750g were removed from each breast.
Just had her first child, normal pregnancy and birth, a boy, birthweight
3880 g (all weights are naked, on electronic scale).  Baby dropped to 3390g
during her four day hospital stay, had passed meconium and urine and was
vigorous, alert and nursing eagerly at discharge.  First check about 2 days
later for PKU and bilirubin check, baby at discharge weight, nursing hourly,
passing urine several times daily but no stools.  Bili around 280 (under
limit for lights but over limit for stopping follow-up)  Still alert and
content as long as he was at the breast.  Next check two days after that,
baby up to 3415g, still no stools but passing clear urine several times
daily and still content at the breast, though looking scrawnier.  Bilirubin
dropping but still over limit for stopping follow-up.  Mother very reluctant
to supplement as she is confident she can BF, but is feeling that some ABM
before bedtime might be OK.  Starts to give 60 ml after BF late evening and
baby sleeps 3-4 hours after this feed, much longer than at any other time of
day.  Mother not unhappy about that.
By day 10, still no stools, baby weighs about 3500 g and still nursing
constantly.  Mother can express small amounts manually but as she is nursing
so much we feel pumping has no real purpose.  By now, well-baby clinic is in
touch with her and a very supportive nurse gently brings up the need to get
more food into this kid.  I also feel his weight gain is so pokey that it is
making me nervous, though he is alert and interacting happily with her, his
father and anyone else who crosses his path.  Bili level is below limit for
concern.  Plan is to start giving him more frequent supplementary feeds
after BF, 30-60 ml according to what he seems to want, until he starts
stooling and reaches birth weight again.  We discuss a supplementary nursing
system to preserve BF as long as possible, they get equipment to try it out.
My colleague sees them once or twice as I have some time off, and he
continues to creep upward in weight and starts filling his diapers.  At the
last visit yesterday, he was up to 3800 g, had gained 300 g in 6 days, a
real record for him, and is STILL nursing happily at every opportunity, plus
receiving 60 ml of formula four to five times in 24 hours.  Mother reports
that she now can express a stream of milk and feels her breasts are much
more productive.  The SNS didn't seem to offer any advantage for her, as
baby is still raring to go at the breast despite multiple feeds by bottle.
She and father both enjoy getting to spread some of the work/contact and
father is incredibly supportive of her stick-to-itiveness.
Yesterday I mentioned fenugreek to her, but this is the first time we have
aired the possibility of medicating her in an attempt to improve production.
In retrospect I think I could have done so earlier, but I will confess I
didn't have high hopes at all.  As far as I can figure, she is meeting about
half his nutrient needs at day 14, and seems to be steadily increasing her
supply.
pleasantly surprised in Kristiansand,
Rachel Myr

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