I spoke with the mother in my complicated case (briefly: breast reduction,
hormonal imbalance, difficult birth with baby with broken clavicle, deep
suctioning 3x, poor feeding, evidence of respiratory probs, and resultant
FTT).
Baby has been able to consume the approp. number of oz of milk (19-20) per
24 hrs once paced bottle feeding was instituted. Mother notices that the
baby is very disorganized at the start of feeds, with wheezing and some
stress cues, however she regularizes as feeding/pacing proceeds. She is
less reactive to pressure on her affected shoulder, and moves both arms
freely now. She is more wakeful, stooling more often. Her respirations are
still noisy, esp. when supine. She experiences periodic apneiac episodes
where mother "waits for her to take a breath". I urged her to move her pedi
visit up and see MD this week and to specifically discuss this. Baby is in
bed with her, and she and husband listen to baby breathing "even in our
sleep." Which is, I think, a good thing.
The milk supply remains depressed in spite of all interventions. To re-cap:
Mom pumped as per hospt. instructions first week pp at q 3hr intervals very
faithfully. She obtained vols. of pumped milk from 8-12 oz. per 24 hrs.
She was also nursing, tho baby didn't really suck, just chewed at breasts.
The 2nd week, she double pumped at q4 hr intervals while cont. nursing and
lots of skin-to-skin. Milk vols stayed around 8-12 oz. She began pumping
at 2 hr intervals round the clock for 3 days over weekend. Today is Day 4
of that regimen and vols are still at 8-10 oz. She states she can't keep
this up, and intended to wean before we spoke. I've given her permission to
drop back to 6x a day, which she thinks she can handle. We spoke about the
impt. benefits of partial supply -- esp to baby who is having difficulty.
Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates, Austin, Texas
http://www.jump.net/~bwc/lactnews.html
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