I'm working with a collegeau and asked her permission to post her
situation on Lactnet.  Any thoughts or advice are appreciated.  She is a
nurse who has also had some lactation training (a five day course) and
she has successfully fed 2 previous babies (7 & 13 years ago).  She said
she always had "tons" of milk with both of them.  She had a home birth
and lactogenesis occurred within 36 hours.  Her midwife delayed cord
clamping for about 2 hours because she said research has show a decrese
in jaundice and weight loss when you wait until the cord has completely
stopped pulsing (anybody heard of this?).  Baby was 8#5oz at birth.  I
belive at 2 days wieght was at 8#1oz.  Mom thought things were going
great at this point.

At ten days she took him in for his first check with the PA and he was
at 8#3oz.  He only poops about once a day, but has lots of wet diapers.
Mom felt like her milk supply had gone way down - she had been under a
lot of stress.  She called me on 4/10.  PA said bring the baby back on
4/13 for another weight.  She also called her midwife who came back to
weigh the baby with her scale (it's one of those that's like a hammock
that you hold up in the air).  Weight was 8#4oz on 4/11 (1oz in 2 days -
but different scales).

I suggested Fenugreek and More Milk and pumping after feeds.  She was
pumping about 1 hour after feeds and I discouraged this.  Then I saw her
the next day and at that point she was just brestfeeding because he was
on the breast so long (45 - 60 min) every 2 hours.  Her midwife also
gave her Pulsatilla to increase milk supply.  She felt like her supply
was increasing.

She has large nipples (she thinks they are larger than with last
baby)and it looks like he gets a good latch - he has a big mouth.  But
the nipple has a compression strip across about half to 3/4 of the end.
Baby also has a notch at the end of his tongue, it looks slightly off
center, but frenulum looks fine.  I checked his suck and he didn't want
to suck on my finger at first, but he eventually did, but never really
established a good rhythmic suck on my finger.  He didn't cup deeply,
but it felt like a pretty strong suck.  He looked like he was sucking
rythmically at the breast.

Her PA and the midwife keep telling her not to worry about the fact he's
not pooping much - but I keep saying it is cause for concern because his
weight gain is inadequate.  I said we want to maximize her supply  until
he grows into her nipples.  She also supplemented for a day with milk
she had pumped when it first came in.  She gets another weight check at
the PA's office today.  She said her midwife was willing to come every
1-2 days to weigh him and I discouraged this because I think a baby
probably doesn't gain an ounce every day, but fluctuates over several
days and too freq. weights just make a Mom crazy and anxious if it's not
"enough".

TIA

Andrea Tran RN, IBCLC
Boulder, CO (where we got a foot of snow 2 days ago and it's supposed to
be in the 60's today)

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html