Pat --

A few add-ons to the suggestions so far:

--  If the baby is developing a blister on top or
bottom lip, remind mom (& the crowd) that the wet
underside of the lip must flange and cover the breast
tissue.  (dry against dry = friction)  This can be
another reason to double check frenulum.  If on top,
check top lip as well.

--  If mom is tempted to use a pacifier, show her how
to offer her upside-down index finger allowing the
baby to take it in until the fleshy part of the
fingertip hits where the hard palate meets the soft.
Tell mom this helps the baby remember to keep the
tongue down and assists with a wider latch.  Encourage
mom to soothe baby while bend of her finger is on
baby's tongue to help baby understand it is normal and
comforting to have weight / pressure there.  She may
try this for just a minute, skin-to-skin & breast
ready, before offering the breast.  (Crowd may benefit
from an explanation of reasons pacifier undermines
mom's goal.  Big point:  MOM'S goal.)

--  Guide mom in trying positions that keep the baby
more upright.  Keep head, shoulders, hips aligned.
Support baby fully, neck to feet.

--  Encourage mom to experiment with gentle massage
and/or compression to inspire baby.  Encourage her to
keep baby skin-to-skin as much as possible.  Encourage
"discovery."  If baby still needs encouragement w milk
flow, a tube at the breast may help  --  but my bias
is always to work hard with breasts, hand, voice, baby
before pulling out "equipment."  It's nice to present
attitude & evidence that her body will work for her.
If you have to pull out "equipment" I like to frame it
in the context of a shortcut back to where her body &
baby want to be.  (ie.  Equipment is just a detour,
not the new path we're taking.)

--  Encourage frequent feeds.  This helps avoid a
hungry baby crossing paths with a frustrated mom.  If
necessary while adjusting frequency, cup feed a bit
just before to help baby relax & organize.  Healthy
newborns with full access to the breast nurse
frequently (if there is such a thing as "normal.")
Frankly I wouldn't be concerned about 1.5 oz if it was
happening every hour or so!

--  Lose the crowd.  This could be a teachable moment
for everyone concerned re mother's ability to letdown
"normally" in response to the baby as well as the fact
that mother & baby are forced to experience an
intimate moment (their budding bf relationship) in a
stressful high-tech setting.  It will help Mom to know
how to lose a crowd at home.  It will help staff to
know that giving the bf couple at least the semblance
of privacy helps bf happen.  It's easy to lose track
of the fact that while HCPs see moms under the
scrutiny of hospital lights every day, moms do not
often find themselves in this setting.  We could all
use some reminding that when a woman enters a hospital
to share birth, death, or another intimate life
experience (such as suckling her newborn) we should be
sensitive to her experience.

--

How old is this baby?  Why is there a "cast of
thousands?"  Are some of the thousands family members
or other potential helpers?  And about that 1.5 oz
transferring  --  I would be a cheerleader for all
milk the baby is "earning" on his own!  You may want
to see more & more often but I would be quite positive
in expressing this to the mom:   "He's got a good
start -- he certainly knows where his milk is coming
from.  Now let's see if we can help him become more
efficient/productive/confident!"


Susan Johnson  MFA, IBCLC






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