I'm not sure if I posted this, but here goes---- I've been working with a
mom for three weeks now, they first came to me at 3 wks pp. Baby #5, all
previous breastfed, #4 and #5 having bfg/wt gain problems. Ped's office
where I work sighed about them, say that all of the kids "have problems",
lots of allergies and illnesses other problems.....  I corrected some L-O
technique, and pushed mom to feed a little more frequently; I also
tackled her diet and removed dairy, since there was a family history of
problems. Management didn't really seem like the bottom issue, and my
only guess was that perhaps allergies were interfering with wt and
growth, though the diapers were just in the acceptable range. Mom was too
busy to keep good records for me, so I was working on pinning her down so
that I could rule out inadequate intake.

At visit 2, I discovered a sore-nipple issue; this mom wasn't a
complainer, hadn't brought this up until then! Great! So I got really
focused on that positioning. Nothing else in hx to flag....

Until visit #3. Mom says that baby seemed to be doing better, milk supply
seemed to be increasing, for the past few days. I asked if anything had
changed, since I knew that she and baby had been sick recently..... she
said, "well, you know, I had some terrible cramping and bleeding one day
last week, and I passed this big piece of what looked like placenta....."
She didn't understand the possible correlation, but when I asked her if
the situation had improved after this, she verified that fact. Then dad
spoke up and mentioned how the doctor had been pulling on the cord and
placenta right after birth, as if to speed up the process so that he
could go home......  it all added up to me!

I'll know in the next week or so, if all continues to go well, that a
retained placental fragment was probably the culprit of our low wt gain.
Looking back, I don't know how I could have caught this earlier, since
mom was so understated in personal complaints, and described what
appeared to be normal lochia at 3 wks pp. One of those hindsight things...

Thought this was an interesting case to share.

-Lisa

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Lisa Marasco, BA, LLLL, IBCLC
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