To briefly introduce myself, I am a Maternal Child Clinical Nurse Specialist
at a large HMO in California.  I work with mothers with high risk
pregnancies.  I am also a Certified Lactation Consultant who plans to sit for
the IBCLC exam when I have some time to study.  Soon, I hope!

I have a patient I would like to discuss with the group.  She is a G1 P1 21
year old who had a 7Lb 10 oz baby girl 2 weeks ago.  Breastfeeding was
initiated 20 minutes after birth and baby latched well with audible swallows
from the first nursing.  She nursed well for 5 days with frequent stools and
wet diapers while the patient had a doula in the home and was waking the baby
to feed every 2 to 3 hours.  When the doula left the mother waited for the
baby to cry for a feed which she didn't do for 5 or 6 hours (even longer at
night).  When I saw the baby on day 12 she was lethargic, had gained 1 oz
since birth and was passing green stools. The baby would no longer latch or
even root. I encouraged the mother to finger feed the baby pumped breast milk
which was supplemented with abm since the mother could only pump 1/2 to 3/4
oz every 2 hours for the first day.  I advised her to offer the baby the
breast at each feeding after the baby had been hydrated and was more alert.
 The baby rooted a little but was unable to latch for more than 2 or 3 sucks
at the 2nd visit 2 days after the first visit.   She was voiding and stooling
breastmilk stool at each diaper change.
Mother was now able to pump 3 to 4 oz  every 2 hours and is not using abm any
longer.

I am pleased with baby's progress and know that this baby will be able to
return to the breast with encouragement.  Mother wants to breastfeed and is
willing to pump as long as it takes to get the baby back to the breast.  I
have suggested lots of skin to skin contact and would like to suggest having
the baby join them in bed for close contact with Mom, but I am hesitant since
they have a water bed.  I have not heard whether waterbeds are safe for co
sleeping with a newborn and would like the comments of the group.

Thank you.

Nancy Coulter, RN, CNS, CLC
Granada Hills, California
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