The main thing would be to have close followup with the dyad. I would
discuss with mother s/s of trouble, as Cathy Genna described so well. I
would recommend weekly weight checks. The baby may not gain robustly, as a
well baby would, but should be monitored for steady gains. Also a big jump
in weight can mean a fluid overload. I would like mother to have a hospital
grade pump on hand, if the baby did tire out and had fed ineffectively, or
for back up so mother can stockpile some milk for the surgery and
hospitalization ahead.

Personally, I would discuss with the baby's doctor, the change in plans.
Since you are working for the mother, discuss this first with her. You can
tell the doctor what you observed, that the baby bf well and had no s/s of
problems, and that you would like to follow them with wt checks, etc. That
the mother is very emphatic in her desire and decision to go ahead and bf,
and that you would like to be able to give him weekly reports. That you have
discussed with mother what s/s to report to doctor right away. You could
find some articles or abstracts and fax them also.

Laurie Wheeler, RN, MN, IBCLC
Mississippi, USA

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