I recently had a case in which mother was having her 4th baby, with a fairly
long interval since last birth, but had bf x 12-15 months with others.
Everything seemed to be going well in first 2 days, then I was off, and when
came back, they were still in hospital with baby under phototherapy.
The weight loss was 9% on day 3 and mom's supply was very low. Had not
increased after 72 hrs, and I was expecting it to since mom was a multip
and was exclusively bf and a staunch bf advocate, so no supplements etc.
Baby was sometimes at breast for 4 hours without stopping, according to mom.

Upon questioning to see what was going on, it turns out mom had been on
reglan for last 5 mos of pregnancy for irritable bowel syndrome, and upon
entering hospital to have the baby, the dr. did not order that med. This mom
was also quite anemic with a hemoglobin of 6, and her dr. was treating with
IV iron infusions. When asked about meds, of course mom did not tell me
reglan becoz she was not on it.

The dr. wanted baby supplemented but mom didn't want and so with the nursery
nurses we decided to try without supplements. She bf as much as possible,
with very little milk transfer noted. She pumped after, with very little
output (few ml's) and syringe fed this ebm. It came to pass that baby was
crying inconsolably and looking very dry, and was supplemented with mom's
permission by syringe with formula 1 oz every 3 hrs after breastfeeding.
(The baby was on a 3 hr schedule - not ideal of course - at this point due
to being under double phototherapy). The next day baby had lost another
ounce, to 10 percent, and mom's milk supply was increasing but not
abundantly, with mom getting about an ounce each pumping. The Ob started her
on reglan again, and I cautioned her about abruptly stopping it. I believe
the anemia and the stopping of the reglan contributed to the low supply
situation. The couplet left hospital with plan to bf ad lib and continue
pumping and giving all ebm and formula if needed for low output or unable to
satisfy hunger and follow up in one day for weight check (not following up
with me, but in another city) and to continue followup til supply is up and
baby gaining well. Mother did not want to use supplementer but choose to
syringe feed any supplements. Possibly if baby was "allowed" by peds to stay
24/7 with mom and bf ad lib, we could have avoided any formula use, I'm not
sure.
This mom got some bad advice like baby is using you like a pacifier, so just
give him one, no one was looking at the whole picture.
It was an interesting case.
Laurie Wheeler RN MN IBCLC
Mississippi USA

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