I appreciate so much your thoughts everyone.  Thanks for taking the
time to put it out there.

Let me clarify that it's very difficult for me, when writing emails,
to assess which info is critical and which is extraneous.  Everything
feels important to me and I tend to be overly wordy. However, since I
was making an effort not to bog down readers with unnecessary details,
in my attempt at brevity, I may have omitted information that  was key
in painting a clear picture.

<<On Fri, Jun 5, 2009 at 12:35 PM, laurie wheeler<[log in to unmask]> wrote:
> First of all, I would be very concerned about any mother who had breast
> reduction surgery, and who did not have close followup.>>

2nd.

<<> I am aware of the various sources that give appropriate wt gains and time to
> regain birthweight...snip..... I
> think a consistent gain of 4-5 oz per week is ok, but what worries me most
> is that baby was not followed closely when at first he lost significant
> weight. By significant I mean "take notice of this" and not necessarily the
> baby was in significant danger at 9 percent. The baby needed to be weighed
> much sooner after his birth, in my opinion, and much sooner (48 hrs ?) after
> the 3118 g weight.>>

Mom didn't have the data available when she called me but she was
weighed more frequently. It's unclear why no action was taken at that
point.  However, since we had since established a positive trend,
focusing on 'what should have happened' in that 14 day period is
generally not going to be helpful.  I do wish I was there earlier.  I
wish they had called.  I wish she'd considered that the surgery may
have impacted breastfeeding rather than buying the surgeon's line
unchallenged when he said, "breastfeeding?  this won't have any impact
on breastfeeding.  someone women can breastfeed.  some can't.  if
you're one that can, you'll still be able to.  this doesn't change a
thing'.

Interestingly, when she called me last night, it was to ask (irt my
youngest daughter) if I had 'problems with L's weight gain from birth
or was that something that developed over time'.   While I knew about
the surgery, she didn't bring it up right away, nor did she bring up
breastfeeding, instead focusing on the peds concern about weight gain.
  At first, I was sure she wasn't breastfeeding since she didn't even
bring it up.  I asked the questions we ask and she was willing to
eventually tell me that the ped was concerned with her breastfeeding
b/c of the surgery and that she was exclusively breastfeeding the baby
with the exceptions of the 3-1 oz bottles of formula early on.

In the limited phone time I had with her last night, I chose not to
'stay there' (the significant and sustained loss) simply because there
was a positive trend towards gain, a baby that slept well, seemed
satiated after feeds, had wonderfully alert times, was not lethargic
etc.    No pacifiers have been given.   Mother reports baby has been
given an ounce of formula three times.    I did forget to mention a
critical point: a 24-hour 'baby nurse' was in the home for the first
two weeks of the baby's life.....an unfortunate southern thing.
Seems highly likely that during this time there was not an appropriate
frequency of feeding going on and that in combination with other
factors weight gain was not happening.

The mom is using no pacifiers, not limiting breast time, willing,
interested and able to feed baby at any cue.

Susan B wrote:
<<You can NOT look at weight gain or loss in isolation from those
other indicators because it
becomes meaningless. >>

Good thing I didn't:)   I wanted data for the ped (and I still haven't
been able to find a cite supporting that LLL 4-7 oz) and wanted an
overall opinion just to be sure I wasn't missing something in this
baby for whom all signs indicate she is taking in enough, growing,
gaining, developing appropriately but who did have a delay in getting
process started and who in the last week was nearer the bottom of that
'appropriate range' which triggered a new round of concern from the
ped.

I sent her links for the excellent asymmetrical latch/breast
compression videos, have talked her through the same,  and would love
to refer her to some hands on help achieving an optimal asymmetrical
latch.  Anyone in Birmingham, AL?

We also covered domperidone, fenugreek and using a supplementer at the
breast should supplementation be necessary.

Thanks much,
K in Atl

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome