Dear Friends:
    Every now and then, things go much better than anticipated. There are
blessings in our work, and I would like to share this one with you.
    I saw a mother in the hospital, where I work occasionally, covering for
the regular LC. This mother had insisted on an unmedicated, spontaneous labor
and birth. She had only 2 stitches. She refused to let her baby go to the
nursery. She wanted to see me because she had had breast reduction surgery in 1990.
    She has anchor scars on both breasts, the scar from the base of the
areola straight down to the breast fold plus curving scars under the breasts plus
perioareolar incisions. I told her I didn't know what would happen, but
recommended skin to skin as much as possible and I gave her a Diaper Diary so she
could look for the poop color changes and amounts. She was keeping the baby close
already, and nursing based on infant cues. I also stressed the need to have
this baby weighed within a few days of hospital discharge.
    I saw her 2 days later, as the LC for the agency the insurance company
contracts with. The baby weighed the same as at hospital discharge and, while
she looked great, she didn't root during skin to skin and I wasn't 100% certain
that she was getting enough. She had been pooping enough though, and the color
was a dark mustard color on Day 4. The right breast was so engorged that baby
couldn't latch; it leaked from pores both on the nipple and the areola. The
left breast was easily latchable, and I heard swallowing every 3rd suck. I
stressed the need for a pediatrician visit, and encouraged the 24/7 skin to skin.
    They saw the pediatrician on Day 5; baby still weighed the same as at
hospital discharge = 6 pounds, 15 ounces. (Birthweight was 7 pounds 6 oz.)
Pediatrician said baby was fine, and suggested another weight check in a few days.
    Today I saw them as the insurance nurse. Today is Day 7. Baby has gained
4 ounces in 3 days! She is nursing like a champ and filling her diapers.
Mother's breasts are working great. She has sensation in both nipples and baby is
beautiful. Mom says "I love my baby" while nursing.
    Everything is working. The breasts must have re-energized and reformed
during the 14 years of periods and a pregnancy. I got to follow this dyad from
the hospital to the home. I will still call them and be available to her as
needed; I referred them to the local nursing mothers group.
    Thankful,
Nikki Lee RN, MS, Mother of 2, IBCLC, CCE, CIMI
Maternal-Child Adjunct Faculty Union Institute and University
Film Editor, Journal of Human Lactation
Support the WHO Code and the Mother-Friendly Childbirth Initiative

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