In a message dated 5/24/03 11:34:31 PM Eastern Daylight Time,
[log in to unmask] writes:

> Mother has given me permission to post her situation. Mother was dxed with
> mild MS about 3 years ago, presently in remission. Gave birth to 36 wk twin
> boys 10 days ago, C-Birth. Was pumping fine and one baby at breast until 4
> days ago. Changes were: nursing baby developed nipple confusion and mother
> was convinced to change from a Lactina (with which she was getting an
> adaquate supply) to a Classic. Within 3 days on Classic milk has dropped
> from 3-4 oz per q2h pumping about .5 oz.

 If I'm reading correctly, this MOT is pumping 12x/24 hours and was getting a
total daily volume of 36oz (1080ml) to 48oz (1440ml) with the Classic, but is
now getting a daily volume of 30oz (900ml) to 42oz (1260ml)? I'm with you re:
moving back to the Lactina if that is the only difference/only thing that
changed in her routine. However, production seems WNL, so I'm wondering why there
would be a need for a galactogogue at this point. (I work with a lot of MOT
and find most are not pumping as many times in 24 hours as they first
indicate--just seems like it to them. I'd suggest looking very deeply into basic pump
management re: pump "recall" for number of actual pumping session in 24 hours
and pump routine/use of equipment to assess actual milk removal opportunities
before moving to a galactogogue.)

I'm with you about the possibility of maternal overhydration. The research
evidence does not support X amount of fluid as associated with increased
production. But you've shared that with her and you aren't responsible for what she
chooses to do. And from your post, it sounds as if this mother may indeed pick
and choose interventions for reasons that don't always make sense and she does
not appear to be the most reliable transmitter of second hand info, as per
the cup-feeding info she said the hospital told her vs. your experience with
that hospital and its LCs. She also hints at being a "yeah, but" client. C'mon--a
woman buys a glucose monitor without medical rec, but then can't remember the
results? Sure...

> ...One baby is home, one is still in NICU. (The baby in NICU was the one
> who was nursing before bottles were introduced.) I asked about cup feeding and
> she said her
> hospital "won't do it."

I've moved away from believing in "nipple confusion," per se. I'm more a
believer that a baby either can't suckle effectively yet re: CNS, mechanistic or
systemic reasons or the baby's been given the wrong teat--one that reinforces
neurobehavioral responses in the oral cavity that are contradictory to
neurobehavioral responses needed for BF. I've had too many MOT transition babies from
bottles to breast or continue to alternate using a more BF-friendly teat.

This MOT has a lot on her plate after a pregnancy and birth that typically
are more complicated, plus the MS concern always hanging over her head. Having
one baby in NICU and the other in her care can be very stressful; mothers who
experience this often say they constantly felt they should be with the other
baby. She may have said the hospital doesn't cup feed because she elicited a
response from care providers there that "fit" with wanting to do what often seems
less stressful--bottle-feeding, which is more socially understood. It may be
that she doesn't want to/can't think about one more thing just now, or it may
be that she's a borderline personality.

I hope some of the above makes sense and does not come across as
smart-alecky. It isn't intended that way. This MOT has a lot on her plate but she's also
sending you mixed signals about BF. We do our best but mom is always the
"gatekeeper" when it comes to BF or expressing milk for her own infant(s)! Good
luck...

Karen G


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