Wise ones,
I have an urgent and complex situation on my hands... would appreciate any
input.
Permission to post. I appologize in advance for the length of this post and
for not proof reading:
Suspected PCOS in mother, but no formal diagnosis. Took two years to
conceive; natural conception just shy of starting fertility meds. Maternal
age: mid to late 30's.
Traumatic birth (16 hours of labour resulting in c/sec), lots of post partum
edema. LII very slow. No dramatic increase in volume of milk, just a slow
build over the first two weeks.
I orginally saw dyad at 1 week post partum. Diagnosed tongue tie - parents
elected not to pursue treatment at that time. Infant was latching okay, but
some what shallowly, though not that 'bad' in comparison to some... no pain
or discomfort for mom.
Cranial asymmetry also diagnosed, and chiropractic treatment was sought. I
think parents felt that treating the asymmetry was 'enough' and would
suffice. They thought that frenotomy was too invasive and would wait and
see. Also, around here it's difficult to find a doctor who will do a
frenotomy - it's totally hit or miss.
Mom was supplementing due to 11% weight loss in infant, supplement was about
25% of infant nutritional needs. Suggestions were made to increase maternal
milk supply and wean infant off supplements. Outcomes looked good, milk
supply expected to continue to increase due to patterns at that time, infant
was latching regularlly and feeding well at breast, appearing satiated,
though did want to feed every 1.5 to 2.5 hours. Mother was happy to ablige.
Approximately in week 5, infant weaned himself off all supplements. He
simply would NOT drink from a bottle, nor a cup, nor a syringe. Mother
tried the SNS, and he refused to breastfeed with that attached. He wanted
the breast, and only the breast.
Turns out that maternal milk supply was not where it needed to be and
supplement was what was keeping the baby growing. Once he began to refuse
all supplementing forms, he began to lose weight. His pattern has been as
follows:
Weeks 1 - 5: average of 9oz gain
Week 6: 5oz gain
Week 7 & 8: 3-4oz gain
Week 9: 1 oz gain
Week 10: 1oz LOSS
Infant will be weighed again tomorrow (Monday, July 25), but mother reports
that his wet diapers have decreased by HALF since Friday.
I was called in again recently (nearing week 10) and observed an EXTREMELY
ORALLY CHALLENGED baby. Latch is much shallower than when I saw him at week
1. He drinks when mom lets down, and then when milk slows, he cannot
maintain a seal. Digital exam reveals nearly non-existent suck reflex, very
poor seal, and very little response upon stimuation to lips and tongue.
Naturally, his tongue bunches and he has little, if any lateral movement of
his tongue. When offered a cup of expressed breast milk, he does not even
attempt to make a swallow, but just lets the milk fall out of his mouth. It
is very easy to see why he has refused all supplement forms: It's very
tramatic for him, and he simply does not have the physical ability to manage
the oral invasion of bottles, cups, syringes.
I spent a considerable amount of time with him yesterday, attempting to
finger feed while playing. Simply had a tube taped to the side of my finger
and played with him... whenever he let me, I'd slide my finger toward
junction of soft/hard palate. After about 15 minutes of such play, he'd was
finally able to for a seal around my finger, but it only lasted a second.
Then, we'd have to start over. As you suspect, he chews and plays with the
finger more than anything. He did manage to swallow about 5 mls of
expressed breastmilk in this low intervention, playing method.
Baby is healthy and well in every other respect. Happy when not hungry.
It is beyond obvious that baby needs a frenotomy... oh yeah... on both, that
is. Lingual and labial, as his labial frenulum is also very tight. I am
working to get this mom a referral to an area peditrician who I have heard
is really good, and will treat. Cross fingers.
Now then... mother: Naturally, her milk supply dwindles becuase of shallow
latch and poor stimuation of breasts over past two months. But, her case is
more complicated than that, given the suspected PCOS and infertility issues.
She's been on domperidone since about week 2 and was doing okay with it
until baby weaned off supplements.
She'd had prolonged post partum bleeding (stopped at 54 days, one week with
no bleeding, then resumed again. A few days of no bleeding here or there,
then it continues). Her family doctor suggested she take the mini pill in
an effort to control the post partum bleeding (prolonged bleeds were an
issue for her before she conceived). She noticed an INCREASE in her milk
when the progesterone was started via min pill, but chocked it up to the
fact that baby was off supplements and therefore may have been at the breast
more or longer, causing more stimuation and increased milk.
Nearing week 10 (when I was called in) and baby was demonstrating a weight
LOSS, she decided to go off the progesterone and add herbal galactogoues
instead. Given that baby was now losing weight, we decided to attempt to
jump start production with goat's rue, more milk plus, and mulunggay.
Because the progesterone had not had is desired effect (ceased the menses),
it was felt that it may have added to her milk production issues, so it was
ceased.
However, since stopping the progesterone and beginning the herbs, she has
noticed a significant DECREASE in milk production! Her supply is in major
crisis, as it appears to be decreasing rapidly. A week ago, she could pump
2 oz after morning feeds. A few days ago, she was pumping only 1 oz after
the morning feeds, and today, only 1/2 oz.
A fertility specialst suggested that she may have too much estrogen in her
system, and the progesterone may have balanced it out, causing better milk
production. She has begun the mini pill again, in the hopes of duplicting
the effects from when she began to take it the first time. But, no such
luck... she is still decreasing her supply.
Obviously, we are working to get baby treated, and mom has an appointment to
see her doctor for a full hormonal work up later this week.
Meantime... am I missing anything? Does something jump out at you? How can
we get this baby to eat, at breast or any other way?
Thank you for reading all this and for any advice you can provide.
~kg
Karyn-grace Clarke, IBCLC, RLC
Registered Lactation Consultant
HAPPY TRIBE CONSULTING
<http://www.happytribe.ca/> www.happytribe.ca
Nanaimo, BC, 250-739-3146
***********************************************
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
|
