Boy this sounds like a real tough one to figure out!! I had a couple of thoughts
as I read your post for Robin, Lisa, but none are extraordinarily insightful -
please don't be offended by the simplicity herein. If the baby seems to be
overly sleepy at the breast, can the mother: gently waken the baby with an *air*
bath while breastfeeding, gently employ the valsalve maneuver to waken baby
prior to breastfeeding, use a cool washcloth on baby's tummy, legs and feet
prior to or during the feeding, wear baby in a sling sitting upright between
breastfeedings, get some fresh air in baby prior to a feeding (sorry, if mother
is in a cold climate and this is inappropriate), have some rock'n'roll music
playing as mother begins to breastfeed. If this situation appears more like a
nursing strike type of infant response, possibly some quiet, protracted
skin-to-skin time in the mother's bed, or a long soak in a warm bath with baby
positioned at the breast, a few candles for dim lighting, and a hummed
lullabye... If you or Robin suspect that the mother's MER is delayed and the
baby is responding to this by sucking three times and quiting (as opposed to the
mother responding to the lack of sucking stimulation with a delayed MER) then
the last two suggestions as well as possibly refering the mother to someone
trained in maternal-infant massage therapy might be a consideration. Again, I
realize just how very basic this *stuff* is, I felt a need to review the obvious
before I ventured into the next part.
Two more concerns hit me as I read and re-read your post, Lisa. The first is the
kidney stones - though I have no knowledge of a conncection between these and a
delayed MER as such. I have had personal experience with kidney stones that
passed - I'm struggling with the idea that one can eliminate these from one's
body without any discomfort. The residual pain, irritation, general discomfort
might be hampering her ability to concentrate of breastfeeding her new baby.
What alerted this woman that she may be currently trying to pass stones - what
prompted the ultrasound one week postpartum? pain?, discomfort?, routine
examination? Does the mother find any of this distracting to the process of
postpartum recovery? Is she being encouraged to drink excessive fluid in her
attempt to pass the stones?Any other diet/life style changes suggested for the
kidney stones?
My second thought was when you mentioned that the mother has, "...an anorexic
personality, is already back to prepg wt." Is the mother a naturally slender
woman?, possibly with a high basal metabolic rate?, one of those few women who
gain just so much during pregnancy and lose the very same poundage the day they
deliver? (I do believe there are a rare few like this in the world -
unfortunately I am not one of these, though I dream...). Or is she a woman who
when faced with circumstances beyond her control turns to her diet as SOMETHING
in her life to gain control over?, does this mother interpret the baby's falling
asleep at the breast as a rejection of her mothering efforts, as well as her
milk? From your post, I gather that the mother has an unpredictable MER response
to the breast pump as well as to the baby, am I right? Possibly experimenting
with conscious relaxing techniques while pumping might act as biofeedback,
letting the mother learn how and when she respondes with a MER?
Lisa, you also don't mention the two year old's response to the new baby. Was
this positive or negative? Did the two year old ask to nurse? How does the
mother feel about "dividing' herself between the new baby and her old baby?
Also, has the new baby's total weight gain from day 10 to day 15 postpartum
continued to increase? by how much?
The frustration of these kinds of challenges to breastfeeding are enough to make
a committed breastfeeding advocate crazy, aren't they!!
Good Luck!!
Jeanine Klaus, MS, IBCLC
Oakville, Ontario
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