Dear Everyone,
Here is the continuation of the update:

On 5/20, mother said she breastfed first (11 times that day), and was able
to feed a total of about 100 ml diluted ABM (about 25% more water added)
throughout the day by bottle, and thought baby did not like how thick the
formula was, or had trouble sucking it through the artificial nipple whose
hole was small. Baby had 3 pees and 1 poop between 7pm the night before and
4pm on 5/20 when we talked. Mother seems very relaxed, not anxious, and did
not get the SNS, still wanting to try the bottle more. I mentioned
expressing milk after feeds if she was up to it and told her that her
transition to fully breastfeeding was probably going to take a while, maybe
several weeks as she herself is still in recovery, and that the SNS might
be really helpful as she can feed supplement at breast.  They weighed the
baby at home with clothes on using a spring-scale for weighing vegetables
at the market, and baby weighed 2850. I told her that might not be accurate
and that baby should be weighed naked on a real baby scale.

On 5/21 at 5pm, Mom noted 6-7 breastfeeds since midnight (11 over past 24
hours, 2-4 sides). Baby pooped 3 times that night, and 4 pees from midnight
to 5pm, but neglected to record the evening before). In past 24 hours, she
was only able to get the baby to take 90ml of ABM and perhaps 6ml of water
(water feeding is common in China and families persist even when informed
that there is risk because they believe that formula feeding causes
"heat"). Baby fussy and crying a little on and off all afternoon. After
rocking, then breastfeed. Fussy all day, and sleepy at breast, suck seems
weaker, takes longer to feed, constant stimulation.  Mom using breast
compressions. Baby rejecting bottle again - spits out, refuses, cries.
 Napped for 4 hours in the afternoon.  I asked her more about what NICU
staff said at discharge. She said they said the baby was hard to feed and
was fed 8 times a day and took 40-50ml at most.  Mom still had not ordered
the SNS, so I suggested that she send someone to my home to pick up some
small tubes to try. Again, I advised her to express after each feed, or as
much as possible, if she could, and sent her a link to order the SNS
online.  I asked if she could get the baby weighed or buy an electronic
home scale. She said the baby is supposed to go get vaccination the next
day and could be weighed there.

When asked, mom said she was anemic during pregnancy and was on iron
supplements. She does not know if she is still anemic, so I advised her
that anemia can also interfere with milk production and she should ask her
liver doctor about it.

Baby's grandmother came in the evening, and said that at discharge the baby
weighed 2600g (100g under birthweight).  I asked about her daughter's
blood, and she said that there were still a few things that weren't quite
in the normal range, but the doctors gave her meds to take which the family
had already looked up and said were compatible with breastfeeding. Grandma
was concerned about her daughter's body still recovering from a serious
illness, from birth, and from being a tired new mom. She is concerned that
daughter wants to breastfeed too strongly, and after grandma and family
tried to get her to relax more about it, her daughter was very upset.

I calculated that her baby needed to have between 400 to 520 mls of BM or
ABM a day and let mom know that she should try to feed 30-40 ml ABM 6-8
times a day.

On 5/22 at 1pm, mom said baby breastfed 5 times since midnight and also
took a total of 90 ml ABM from a bottle, and 20 ml EBM. She said if the
baby drank one breast and then she expressed the other breast, she could
express 10 ml.  Since 1 am to 1 pm, baby has had 5 pees, 1 poo and is not
as fussy as the day before.  She notices that she has MER during
breastfeeding. At night, baby seems to wake every 2 hours to feed, but is
sometimes fussy when latching, and turns her head this way and that way
getting frantic.  I explained that this might be due to oral aversion, and
she can just try to keep her baby calm, skin-on-skin, let baby lead,
and avoid touching baby's head during latch.  She said baby is not as fussy
as the day before. I asked if baby seemed more sleepy, disinterested in
feeding, weak, etc.  She said it did not seem so.  I again talked to her
about the benefits of using an SNS, but again she seemed to not want to
embrace the idea and just wanted to keep using the bottle. She also did not
use the tubes I sent with her mother.  We talked about her possible milk
supply being possibly only around 200-250 mls if she was feeding 10ml per
breast 11 times a day, but that was very good considering that a week
before, she had not even been expressing. I stressed that the baby still
needed more supplements for a while.  (I am worried if the baby doesn't get
enough, she might be heading towards FTT).

Her baby is not under the care of a pediatrician right now, and in China,
there is no such thing as a dedicated pediatrician. You can't even make an
appointment - just go to the hospital and get in a massive line and hope
you can see someone before the end of the day. There is no care by a
continuous provider who knows you and your history, and no communication
between the different doctors you see each time because the appointments
are usually 5 minutes or less.

She just texted me that the baby's current weight is 2760, which means she
has possibly grown 160g in 5 days, assuming the scales are correct and
accurate (2 different scales used).

Suggestions, anyone?

Thank you for reading all that... my second (and third) post on Lactnet...

Ivy Makelin
IBCLC,
LLL Leader
Beijing, China

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