I want to briefly share the details of the presenting problems of a consult
I did today:

Mother is a 40 yr old primip with a hx of fertility problms which required
progesterone therapy to maintain the preg.
She did not exper. any breast changes during the preg.
She had a breast reduction in 1991, and has reduced nipple sensation.  Is
pumping with hospt. grade pump about 6 x per 24 hrs and gets max. 2 oz total
each pumping.
She had gestational diabetes.
Baby was induced at 37 weeks.
Delivery was unusually rapid and resulted in baby having broken clavicle.
Baby was aggressively suctioned after the birth, which was repeated on 2
additional occasions in the nursery.
Baby is under birth weight at 14 days, very sleepy, and has had episodes of
nasal regurgitation, prolonged crying spells, and aversive feeding behavior
when bottle fed.  Mother offers her at least 18 oz per 24 hrs by bottle, but
baby often falls asleep bottle feeding and won't take all the milk she is
offered. She falls asleep at breast after 2-3 sucks.

I have a plan to manage this case, but I thought it would be fun to throw
out the situation for discussion and brain storming.


Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates, Austin, Texas
http://www.jump.net/~bwc/lactnews.html

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