Nikki, this happens frequently to many LCS. There is often a triangle
set up between patient, LC and MD. Often the LC, who may have a lot of
knowledge, research based, etc, suspects a problem, and often the doctor
can work with this and help the mom to solve the problem, with input
from the LC in a collaborative manner, professional to professional.
Occasionally, there is a turf issue. The bottom line is that the mother
must advocate for herself. You can show her what you know, cite your
references, and let her deal. Unfortunately, that's the way it is.
I know. Makes you wanna hit your head on a wall. Kathleen
Kathleen Bruce RN IBCLC
Listowner Lactnet listserv
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Dear Friends:
I am very frustrated after a home visit I made today.
The mother had never noticed the breast fullness after delivery that
one might expect with a first baby. The baby, at age 11 days, is still
10 ounces under birth weight. Peeing lots, but pooping once a day, dark
color. Mother still having bright red lochia, enough that she is
wondering how long it will persist. Baby latches perfectly to the soft
breast with a fabulous tongue, perfect lip flanging, and excellent
sucking. Listening with a stethescope, I heard only sporadic swallows.
Scale showed 0.3 ounces of milk transfer after 5 minutes on one side and
10 minutes on the other; total 15 minutes. Baby falling asleep; also has
a hollow and hoarse sounding cry. Mother reports that MD made comments
at delivery about how large placenta was.
Baby took nearly 3 ounces of formula after nursing; 1 from a cup
and two from a bottle.
I recommended supplementation with formula and calling the doctor
to rule out retained placental fragments.
Doctor spoke with the mother. "All the placenta came out; I saw it.
Ultrasound doesn't always work. If you are soaking one pad per hour,
come to the ER. Babies can breastfeed when a mother is pregnant, so
there is no connection between the bleeding (which is within normal
limits) and the low milk supply."
Mother is now caught between me and the physician. Feels like a
pingpong ball. Meanwhile, breastfeeding is being compromised, because
baby will catch on instantly that nourishment comes from the cup or
bottle, and not the breast.
Mother has requested that I not page the physician to talk directly,
because physician is very busy today. I shall make a home visit tomorrow
to set them up with a SNS so that baby will still want to go to breast.
AAARGH!! What about prevention? Why does this mother have to
hemorrhage before she is taken seriously? Why doesn't the physican know
the difference between autocrine control and the milk-stat setting in
the first few weeks postpartum?
Thanks for listening.
warmly,
Nikki Lee RN, MS, Mother of 2, IBCLC, CIMI, CCE
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