Hi Lisa,
I would be very quickly working on supply with this mom. It seems she had a
fairly difficult birth, and although mom and baby stayed together and baby
was offered breast, he did not really initiate bf, nor it seems, really "get
into" regular bf for a few days. I think mom might have just enough hormonal
issues that, under those circumstances, the milk supply just didn't "kick
in." Under other circumstances, like a shorter pushing stage, and a quicker
initiation and maintenance of regular feeds, all would have probably been
well. I see this fairly often, where seemingly minor baby + mommy issues add
up to major breastfeeding problems.

I also see fairly often, under these types of scenarios, that babieborn
healthy tend to pee and poop pretty well until about the 3rd day, and then
all of a sudden, the pooping stops. Babies sometimes continue to pee, but
the diapers are not soaked, and often, if questioned, parents will confirm
that baby's pee is pinkish or smells strongly. This typically occurs around
a 12-14 percent wt loss, the most I've seen so far at the 3-5 day checkup in
my Center. One has to ask alot of questions about character of feeds (length
of time, type of suck pattern, strong grasp of breast vs losing his grip
often), and about the character and size of voids and stools. I also often
ask moms if I'm talking to her on the phone, about her milk "coming in." Ask
her to rate it on a scale of 1-10, or does it feel like someone "gave her
implants" when she was asleep. Often moms under these conditions report the
milk came in, but it is not a big change in the breasts, typical of a
healthy lactogenesis II phase.

It seems mom does have some PCOS s/s like infertility, somewhat high
testosterone levels, smaller breasts, somewhat wide spaced - although
nothing DRAMATIC, coupled with the infrequent early feedings, and possibly
ineffective when he did feed, this is adding up to big time trouble.
Therefore, my recommendations would be to immediately begin supplemental
feeds with ebm (mom's or donor, if available) and formula (likely necessary
at this point) at approx 700 mls per 24 hr in divided feeds, about 10-14
feeds per day. I would have mom try a supply line if she is willing and baby
can latch and suckle effectively. I would teach paced bottle feeding as
well. Finger feeding would be fine as well. In my experience, when we are
several days into the situation, and baby so much underweight, and looking
at several days to possibly a couple weeks to fix this, I usually go with
the supply line + bottles. Often mom will use supply line at home, and
bottles if she has to go out with baby (to doctor, e.g.) or if she needs
some help with feedings while she pumps. I would suggest galactagogues and a
rental pump 8-10x per day. She can be referred for the lab work as well,
what you suggested is good. I also agree with the chiropractic treatment, or
CST.

Hope this is helpful to you.
Laurie Wheeler, RN, MN, IBCLC
Mississippi USA

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome