I seem to be having repeated exercises in frustration lately, since taking
over another physician's pregnant patients.
I had a mom 2 days ago who delivered a baby boy 8 lbs 10 oz, first baby, by
vacuum assisted delivery (due to epidural making mom unable to push
effectively and non-reassuring fetal heart tones.) Mom has flat nipples,
worse on one side, baby is very non-assertive at the breast. For the first
24 hours baby would not open mouth really at breast, and fell asleep
exhausted after all attempts. At 24 hours, we tried a nipple shield and
had mom pump, with some success at latching baby with the shield. However,
mom has to be very vigilant to keep the babe from sliding down onto the
nipple. He also continued to frustrate easily, and would let go to cry.
Mom able to express drops of colostrum into his mouth, which helped some.
Breastfeeding sessions were very frustrating for both mom and baby. Mom
felt panicky in the night last night and asked baby to be supplemented with
formula by bottle. Today (about 48 hours of life) baby was latching
reasonable with the shield and more awake. Colostrum is visible in the
shield and in baby's mouth. He stayed awake at breast for nearly an hour,
but then let go and cried, which mom perceived as baby still hungry and she
supplemented with formula. We could not get him latched onto bare breast as
the nipple retracts fairly quickly and he is just not aggressive enough to
get him on quickly while nipples are still protruding after pumping or using
the shield. Mom is convinced he is starving and is fairly insistent on
supplementing, now, but is offering the breast first for every feed. Baby
has lost 8 oz from birth weight (about 5%), but actually is wetting diapers
and had several meconium stools both days.
Meanwhile, the IBCLC is out of town, and it's a holiday weekend. To make
matters worse, I am not this baby's doctor. The pediatrician came and
discharged him today, without even asking the mom if the baby was nursing!
And wrote an order for follow-up in the office in 2 weeks!
The mom would really like to breastfeed. I'm fairly confident that with
appropriate follow-up that they could do fine. However, the pedi's complete
lack of interest in the whole thing really deflated this poor mom's almost
non-existent confidence.
I gave her my home phone number, the IBCLC's number, the local LLL leader's
number, and encouraged her to bring baby back to the unit for a weight check
this weekend, but we'll see what happens. I'm now looking for a tactful way
to tell this pedi that her follow up plan is really inappropriate and
encourage her to either get more involved herself or at least appropriately
refer!
Jennifer Tieman
Family Physician
Mom to 4, including nursling Caroline Rose born 5/31/03
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