Dear Wise ones,
   I work at a high volume (almost 10,000 del/yr) hospital so I see a
lot of 'unusual' cases.  We currently have a mom G3P3 whose first 2
pregnancies were uncomplicated.  She nursed both babies (girls) without
problem.  Her last pregnancy was complicated by severe hyperemesis.  She
ended up on total TPN for over 5 months.  She delivered vaginally at 33
wks 6 days ago.  Her baby (a boy) is stable and doing well.
   The perinatologist who delivered her has been negative about
breastfeeding.  He told her she should not.  Of course, I came along and
told her it is her body and her baby and her choice.  I was then off for
3 days (had to take some vacation time before I lost it).  Today when I
saw her she and her husband asked how she could maintain some milk
supply (as in pump as little as possible) so she wouldn't be stressing
her body too much.  This mom says she had wonderful breastfeeding
experiences with her other 2 children and she really wants to breastfeed
this baby as well.  She hopes to be able at some point to feed this baby
at breast.  She had some special GI studies yesterday (Thursday) that
she understands to have shown that her stomach is only functioning at a
limited level.  Radioisotopes were involved in the study so she is
currently pumping and dumping.
    The gastroenterologist recommended she continue on the TPN as she
gradually tries to introduce more food orally.  She was to start by
trying a pureed diet today.  She said that the perinatologist explained
that the reason he didn't want her to breastfeed was that she was/is
malnourished and it was too much for her body. (This particular MD
rarely, if ever encourages breastfeeding.) I have had one other mom who
was on TPN during her pregnancy, but she was able to resume a normal
diet soon after delivery.
   Is there anyone on this list who has experience with breastfeeding
while on TPN?  I have this mom's permission to ask all of you for any
input you might have.                  Becky B RNC IBCLC
                                       Annandale, VA  a suburb
                                       of Washington, DC  USA
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