In a message dated 5/4/2005 7:44:35 A.M. Mountain Daylight Time,
[log in to unmask] writes:
His birth weight was 7 lbs even and she has not had a follow up
>weight (peds appt. tomorrow) but seems to think he is gaining weight. He
is
>alert and active when awake, nurses readily and has no signs of
dehydration.
Mom is only pumping about one oz or less each session with a PNS. She told
me that last night she pumped a little over 2oz. but only 1 oz again this
morning. She is supplementing him with ABM (about 2oz each feed).
What would they be looking for at this stage? How would it help this mother?
Heather Welford Neil
NCT bfc, tutor, UK
The labs would look for an elevated level of testosterone which could be an
indication of luten ovarian cysts. Some studies have indicated that if a
woman has elevated testosterone and delayed lactogenisis II there is a
preliminary diagnosis of luten ovarian cysts. There are cases where they cysts
resolve post-partum and once the testosterone levels fall the woman then goes
through lactogenisis II. This can take about 30 days. If that is the case with
this mother then we have good reason to continue to encourage her to pump and
put the baby to breast in the hope that she will, eventually, produce a full
milk supply or close to a full milk supply.
If the labs come back showing normal hormone levels then we look at other
causes; latch, infrequent pumping etc. I am not advocating for lab work for
every mother who has a low supply. This mother has never had any breast
fullness with a term baby. Even if she NEVER breastfed or pumped one would expect
her to have some breast fullness and leaking in the first week post partum.
Is there any evidence of no changes in the breast during pregnancy and no
breast fullness post-birth that would lead one to say that this is only a "poor
latch, poor transfer, infrequent pumping" problem?
I do not understand a HCP who does nothing to encourage a mother to develop
a larger milk supply. Even if the OB did not think that labs were warranted
why would he not refer her to a LC or start Reglan or some other course of
action that would encourage this mother to continue to provide ANY amount of
breastmilk for her baby?
The breastfeeding rate here in El Paso is below the national rates for the
US. The state of Texas has the highest uninsured population (medical
insurance) and El Paso (a city in Texas) has the highest uninsured population in
Texas. We can little afford to not to encourage breastfeeding let alone to not
support those women who do choose to breastfeed. There are pediatricians here
who tell mothers that breastfeeding should not be longer than 6 weeks, that
breastmilk is poisoning their babies (i.e. hyperbilirubenimia) and the like.
Not to say that there aren't HCPs who do everything in their power to ensure
a woman is successful with breastfeeding but they are very few and very far
between.
Lizabeth Berkeley, MPH, IBCLC and Christopher Powers, MD and I taught a five
hour course this past Saturday on The Art and Science of Breastfeeding.
Last year 60 area nurses attended. This year about 80 area nurses, WIC
nutritionist and mid-wives attended. Not a MD among them. It is incredibly
frustrating.
My reaction on this case is not just this one mother but many, many mothers
I have worked with who receive poor or worse, plan wrong and harmful, advice.
Those of us who support breastfeeding must first undo the damage done and
then try to establish the right, evidenced based information as the proper
course to take. And try to do this without undermining the HCP or directly
contradicting what they have told this poor mother.
I am hoping that, some day, a mother tells me that her OB was aggressive
about finding the cause of low milk supply and not that he doesn't really care
to pursue ANY course to improve her situation, or at the very least, get her
some answers.
Thanks for listening to me rant.
Christie Pillado
El Paso, TX
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