Hi, All: I'm currently working with a mom (permission to post) whose baby
is 4 weeks old now. At 2 weeks of age, mom called me stating she didn't
think baby was satisfied at breast. Baby still had mec stools but peeing
OK. I had her run, not walk to MD where weight showed same as d/c weight.
At least baby hadn't lost, but obviously no gain either. I got her
pumping, but she reported no significant increase in milk. At breast, baby
latches well, but never kicks in to rhythmic suck/swallow - seems to not be
stimulating regular let-downs. Some milk transfer noted, but obviously not
enough. Mom's history is gastric by-pass a year and a half ago. Got
pregnant less than 3 months post-op (much to horror of her docs, who
advised waiting a year), had normal pregnancy, but rough delivery. When I
saw the baby again at 2 weeks, large unresolved hematoma still present on
back of head from vacuum delivery. Facial bruising from attempted forceps
resolved by then. I feel the baby has dysfunctional suck related to
traumatic delivery and asked the mom if she would be willing to have baby
evaluated by chiropractor. This is not an option as she stated she knows 2
people who have had very bad experiences and her husband (from Ivory Coast,
Africa) would not agree to this. Our speech pathologist has agreed to do a
feeding eval on baby next week.
Meanwhile, mom continues to nurse baby every feeding, and supplements with
EBM/formula prn (not every feeding, mostly at night). She has been using
Mother's Milk tea and last week started fenugreek capsules. I talked with
her yesterday and she states she has only been using 1 suppl. bottle/day
the last couple of days and that she is getting more milk with pumpings.
Baby seems more satisfied now after feedings. My questions are: Her doc
doesn't think Reglan or domperidone are appropriate for her with her
history of by-pass surgery. Makes sense as these are gastric medications
and may increase any dumping syndrome she may be experiencing. The ped was
also concerned about possible side-effects in the baby. The mom said he
told her he sees a lot of "side effects" in babies whose moms are taking
Reglan - what I don't know. I will ask him next time I see him. Have any
of you encountered "side effects" in babies to the point where you would
hesitate to recommend Reglan? I haven't, so am mystified. Also, has
anyone worked with a gastric bypass mom who is experiencing breastfeeding
difficulties that seem to relate to her surgery? I suspect we will be
seeing an increase in nursing moms who've had bypass surgery, as this
becomes a more affordable option for women. Thanks for any input.
Pam Hirsch, RN,BSN,CLC
Clinical Lead, Lactation Services
Advocate Good Shepherd Hospital
Barrington, IL USA
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