Hello, All:  I am having some issues with the assumption that this 10th baby 
will also be insufficient weight gain.  Look  at the message that is being 
transmitted to this mother loud and clear by her HCPs - your milk will not be 
good enough for this baby, either!  I would encourage this mom to demand 
immediate STS after delivery (or as soon as her or baby's medical condition 
permit) and I would encourage her to be very assertive in the hospital about 
24/7 rooming-in and STS.  Breastfeeding is hormone-driven and she can help 
maximize a good start to breastfeeding and maximum milk production if she 
cranks up her and baby's hormone levels thru STS.  Frequent, prolonged STS 
in the early days will raise her/her baby's hormone levels and help sustain 
these high levels for continuing good milk production.  Letting the baby finish 
the 1st breast 1st is also key to a complete feeding.  The clock is a nursing 
mother's worst enemy in the early period.
I'm assuming she leads a very busy life with 9 other children.  I would 
encourage her to co-sleep and wear her baby as much as possible.  I find that 
talking with a mother about her lifestyle while she is still in the hospital helps 
her to come up with a realistic feeding plan for at home and helps her to 
breastfeed longer than she may have thought she could.  A clock may be her 
worst enemy but a sling is a nursing mother's best friend.  It frees up her 
hands to allow her to care for her other children, while allowing baby free 
access to her breast.
Let us know what transpires with this mom.  This is an interesting scenario.

Pam Hirsch, BSN,RN,IBCLC
Clinical Lead, Lactation Services
Advocate Good Shepherd Hospital
Barrington, IL   USA

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