Dear Laurie,

Yes, goodness for her -- 12 days ago, she thought she and her baby were
both going to die and meet in Heaven.

Thank you for your thoughtful suggestions.  Yes, I am very concerned that
they don't have follow-up care.  China is really a different place than
America.  She is a local Chinese and not able to access
international-standard care at the international hospitals.  Just one visit
would cost her 1/3 of her monthly salary.  I can urge her to continue to
get care from the Children's Hospital though I am not sure if the NICU
doctors will continue to see her or not.  But at least there's a patient
history record there. Yesterday the baby went back to the OB-GYN hospital
where she was born to get the vaccinations, so that may be another option,
although they don't have the NICU records. There are often local clinics in
the neighborhood area that maybe can see the baby.  The mom is now in her
1-month confinement so she isn't "allowed" to go outside, which will make
it hard for her to communicate with doctors.

Unfortunately in China, formula marketing practices has infiltrated doctors
and nurses who are quick to offer formula and have no practical idea how to
help a mother who doesn't have enough milk. They think that most mothers
just don't have enough milk.  Almost every baby here is supplemented from
birth.

There is only one other practicing IBCLC I know of in all of North China
and she is Australian and doesn't speak Chinese.

I totally understand and share your concern about the weight and the lots
of pees and poos but no weight gain and sometimes weight loss.

Well, I am up for doing my best to support her.  My throat isn't sore
anymore, finally, but I'm coughing my head off today.  I hope I can put on
a mask and go see her tomorrow. Meanwhile, I'll spend more time on the
phone with her today.... Best I can do...

Thank you again, Laurie.  It's a learning experience!

Sincerely,
Ivy

On Wed, May 23, 2012 at 8:31 AM, laurie wheeler <[log in to unmask]> wrote:

> Hi Ivy,
>
> Well, what an ordeal for both of them to go through! My first thought
> is that she is making more milk than I really would have expected, so
> that is a big positive. You have a couple of serious things going on,
> however. The first is that the follow-up care, which would be
> extremely critical in such a dire (for both mother AND baby) case, is
> not sufficient. The baby's weight gain and overall condition, stamina,
> etc needs to be evaluated in person and with accurate tools. If there
> is any way you could arrange that, I would make it a priority. Even
> with your cold, provided you felt better but were worried about
> exposing them, I think I would put on a mask and good handwashing and
> get over to see them if I could.
>
> Even with the pees and poops, I have seen babies who are losing or
> just staying the same weight for days and days. And I've seen many
> babies weighed incorrectly or with various clothes or diapers on at
> various weigh-ins.
>
> The other issue seems to be cultural, or just meeting mama where she
> is. I would continue to counsel the mother to feed the baby generously
> (at least until someone can evaluate baby's situation). Of course we
> worry alot about parents diluting infant formula. If she believes
> formula causes "heat" then I would try to say very authoritatively "It
> is best not to mix extra water with the formula. You are giving
> breastmilk or breastfeeding every day. That provides all the water the
> baby needs." or "All baby needs is 2 sips of water (boiled, sterile)
> to counteract the heat of the formula." Something like that. In other
> words, allowing her cultural beliefs but protecting the baby's health
> and safety. It appears she really does not want to, or feel
> comfortable with, an SNS or finger feeding. So go with the bottle and
> perhaps give her some tips about bottle feeding in a bf-friendly way.
>
> It is not fair that you have to be the only one following this dyad;
> it puts a great burden on you. I don't know who you could enlist to
> help you with follow-up? Someone from the public health sector, a
> midwife? I'm not remembering everything you said about the healthcare
> system there. Hope this helps in some way.
>
> Laurie Wheeler RN MN IBCLC
> Mississippi USA
>

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

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