Hello all,
I just had to update you on this one.  Just to recap,. Baby born 25/6/02 at 32 wks. weight 1.630 kgs. Mom called me when baby reached corrected date and was discharged from hospital. Mom using silicone shields and very much wanted to bf. Baby was doing great with shields and had reach 3.800.kgs.with limited bfg and neosure. we had decided that if she wanted to get rid of shields, and wanted to give fortifier by SNS then she should call for an appt. I had received a second opinion from the head of the NICU at one of the hospitals where at this stage the MD said that they would not be fortifying. But I knew that this mom was most comfortable going according to her drs. advice. So, over the phone i had told her, to keep bfg all day long, and to ensure that the baby got the neosure (as per Nancy's advice - rather than pump and give HMF) according to the doc's advice. The doc had told her she has to give 300 cc of neosure and limit bfg to 3 times per day!!

Meanwhile, two weeks later the mom called me upset that her supply was dwindling and she had upped the neosure to supplement nearly every feeding.  She liked the idea of the SNS and wanted to come in to see how to use it and to get rid of the shields.  The baby is now 2 and half months or 2 weeks corrected age.

To make a very uncomfortable story short - the mom sat down, baby had gained beautifully, looked great at 4.200 kgs. we spoke of optimizing latch and positioning, of baby and her, baby finally woke and we put him to the breast w/o the shield and the baby latched with no problem whatsoever. The mom just never tried cause she assumed that the baby wouldn't latch on! So, she was pretty shocked. Then, seeing how the baby latched and was content at the breast, I suggested to her to forget the SNS. She seemed to have a perceived lack of supply - and only after talking extensively about supply and demand, did we (I had the pleasure of having another LC present.) hear that she was weighing the baby each and every time the baby fed, and then she topped up the feed with neosure - if the baby ate 10 cc from her, she would give him 50 more, If the baby ate 30 she woulde give  20 etc...... I then explained that this would probably be very tiring and certainly not enable allowing the baby to pace itself and increase supply. It would have the opposite effect. I finally convinced her to weigh the baby once daily - to make sure that the baby was gaining. It was hard to convince her that the baby would get enough, as long as there were indicators that bfg was going okay - i.e. calm, diapers, and weight. I recognized that she was definitely uptight about the weights and measures. I assured her that the neosure that she was giving (at night) would be enough to ensure that the baby got that little bit extra - per her docs recommendation, but by increasing the bfg her milk supply would increase. 

After the first hour and a half with her, she decided that she wanted the SNS. Now my dilemma. The SNS was not really a solution to her specific problem. SHe was bfg successfully, giving a supplement at night which she did not want to give up because it enabled her and the baby to sleep better. The baby had no problem bfg. She would most probably not stick with the SNS, as it is she was overwhelmed with this new baby. Not only was she obsessive about the actual feeding ritual, she was obsessive about sterile conditions. She was adverse to us touching her baby and we repeatedly had to wash our hands. She doesnt' go out with this baby at all. Said that coming to me was a compromise. I really felt bad for this mom and the heavy load the MD's had put on her and her husband. Seemed a bit extreme. 

If not for the other LC (pretty new in this profession)  who said that if she is so insistent on the SNS, then lets show her how to use it. I would have refused in a polite as possible way. I kind of felt that it was like a patient insisting on her MD to prescribe a drug that in no way was appropriate for her illness. I cannot give an SNS without instructing regarding its proper use. But, I opened the SNS and showed her how to use it, and in the end, she didn't even take it!!  She had also stated that she had wanted to purchase the double pumping kit for a Lactina that she received free from another source. So, I figured at least all this time - now going over the two hours - would be well worth it. In the end she didn't buy that either, and after more discussion, I discovered that her husband is fanatically anti - breastfeeding. So, all these other issues came up, and I must say, I was one frustrated LC. I tried to play into what I felt would impress the husband who unfortunately was not present.
I told her that bfg prevented obesity in later life. She loved it, she knew THAT would impress her husband because he cannot tolerate imperfection. OOOooohh, lots of baggage there. In the end, she packed everything up and then saw our slings saying she wanted to buy one. So, my office person very patiently showed her how to use it, and par for the course, she left without buying one!!  You know how we always say, follow your instincts? I should have. The consult would have been that much shorted and I still don't think that I should have been forced by her, to show her re: SNS.  What would you have done?

Just goes to show that each case, until you see them, is so much more complex than what meets the eye.  Taught me alot. I will F/U on Tuesday and will keep you posted.

Sorry for the length. 
For those fasting - have an easy one.
Ellen Shein, IBCLC
tel aviv





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