I've been asked by a fellow midwife to post this to Lactnet for suggestions.
TIA.
Denise
My sister had a 30wk prem (900gm) baby who is now 6 months old (4.7k).
Little Michelle was initially tube fed then bottle EBM / breast on discharge
home. Despite pumping to maintain a good supply of breastmilk (she has
never needed formula), her baby has always been so fickle as to refuse the
breast completely or the bottle completely at times. The feeding regime is
exhausting: breast (she may take well or refuse) followed by bottle EBM (she
may demand this and drink well or absolutely refuse, my sister gets upset if
she gets no where near her 'quota' and persists with force feeding the
bottle, which may take another hour), then she expresses and washes up,
sterilises, etc. She feels, naturally , that she can't keep this up, but
last time she attempted exclusive breast feeding, she nearly lost her supply
and the baby lost weight. She can't go anywhere with this system, loses
hours feeding, hates it, and would love to go onto bottles if that would
solve the problem. However, she would love to breast feed if it was as easy
as it should be, and is reluctant to wean as she has a decent supply. The
past days her supply seems to be dropping, and she has needed to use heaps
of her frozen EBM supply. Chris has tried many times to feed baby Michelle
using the 'supply line', but she simply refuses the breast, and of course
gets no reward when not attached and sucking. She prefers the bottle,
despite enjoying a breastfeed at times.
Next problem, the worst at present, is my sister's insomnia. This is not
just baby related, as the baby settles and sleeps reasonably well at night,
The problem of insomnia has been an on/off one for many years but is so
severe currently, that she gets a broken 1 - 4 hours sleep in 24. She uses
behavioral sleeping tequniques, tapes, temazepam (on/off), prothiaden (25 -
50mg nocte), etc. Absolutely nothing is helping this time( 4 weeks) and she
was prescribed Prozac by her GP. The baby's paediatrician does not want the
baby to have breast milk containig Prozac or Zoloft at all. Bub has had
neutropenia (secondary to trimethoprim) and a duplex renal system on
prophylactic antibiotics (now, keflex).
Is her only alternative to wean onto formula to treat the feeding
difficulties and the pathological insomnia? Locally, I spoke to the psyche
units where they treat post natal depression and they tend to get their
mothers to wean if admission and treatment with Zoloft/Prozac/SSRI's
required. The product information is pretty negative about these drugs and
lactation, as sent to Chris by her paediatrician, with his letter strongly
discouraging breastmilk containing meds for Michelle. A professor asked why
Chris would be prescribed antidepressants for insomnia, anyway. Is this
appropriate? No doubt, she is distressed, anxious, symptomatic, panicky, a
bit paranoid, emotionally flat, but secondary to severe sleep deprivation
and long term stress we believe. Settling her insomnia could solve the
problem, but in the reverse, settling her distress should help her sleep.
Prothiaden causes many side effects and she finds it does little to help her
sleep. Even the maternal/child health centres in Sydney do not like to give
Zoloft to nursing mums, unless an older baby on solids and alternative
drinks, also. Valium and Polaramine have been vetoed too. Helpful herbal
preparations may go through the milk, too.
Where's my magic wand, I seem to have misplaced it?
Just a note about her history: infertile 5yrs, IVF pregnancy, 13 wks
bleeding, positive triple test for Downs, U/S also consistent (which the
baby did not have with chromasome test after birth, but it was presumed
during the pregnancy), # arm, fulminating pre eclamsia, emerg C/S, severely
unstable post delivery on antihypertensives, stress. Whilst not suffering
clinical depression, she is severely distressed and in need of practical and
pharmacological assistance. She has also had to deal with my unexpected
pregnancy (our 3rd bub) which was discovered whilst I was giving her BD
hormone injections for the IVF (timing!?), comparing her disasterous
pregnancy/problems with mine, and my big 4.2k baby 6 weeks after her tiny
bub, who she sees as miles 'ahead', breastfeeding well (again) and sleeping.
Any reply appreciated,
****************************************************
Denise Fisher, BN, RM, IBCLC
BreastEd Online Lactation Studies Program
http://www.breasted.com.au
mailto:[log in to unmask]
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