Hi everyone. I want to share a event that just happened to me during a
follow up breastfeeding visit.
Permission to post:
Friday pt comes to clinic and baby only transfers 12 cc at 7 days of age.
Baby is jaundice and lethargic. I call pediatrician and proceed to provide a
plan of care for my client...It is a "mystery" why she doesn't have more milk,
everything else "looked" normal. Mom is exhausted from feeding every 45 min
for past week. I get an order from OB for Domperidone just in case. (she
hasn't used it yet and may not ever need to)
After scratching my head i just cannot figure this one out. Then Dad says to
me that he is noticed a unusual smell from wifes body. He proceedes to give
me more details, so I called the OB on-call as this does not sit well with me,
sounds like something she needs the doctor to look at. At discharge teaching
time we tell moms to call the doctor if they have any unusual odor, temp
soaking pads etc.
I call doc back after just getting the dom order, I explain exactly what the
husband told to me. He explains that it is probably just stitches healing inside
and that can give off an odor and to wait and see her on Monday.
Saturday I get a call from a worried husband that moms is at the breaking
point. She still needs help, they worry about how much baby is transferring
etc. I say come on in to clinic and we will take a look at things.
Baby transfers 70cc the very next day, with bright eyes looks great! Mom
however is not looking too good. She is worried about the "odor" and is taking
2 showers/day. HMMMM. As I sit next to her, I can know smell something and
I know all is not well. At this point I am thinking I hope there is
nothing "forgotten" in the birth canal as the stitches were being placed, a
gauze pad maybe. I am praying its not that. We go to exam room and i get a
look at lochia amt color and odor. This is NOT normal lochia smell and I call
the ER and we go over. (The clinic is next door to hospital). After the usual
wait and triage she gets an ultrasound then the ER doc does a sterile spec
exam, not exactly what you want when you are just healing from birth 8 days
prior. As soon as speculum is in he askes for forceps and pulls out a piece of
4x4 gauze, greenish and putrid smelling. This poor woman, I keep doing
guided imagery to help her deal with the pain, and the plain humiliation she
must be feeling. So, my point here is listen to the patient and any significant
other, I wished I had done this the day prior, but I trusted the doc and didn't
dig any deeper. So, my assumption is that her milk will probably be more
plentiful than ever after removing a foreign object from inside her, no she
didn't have much of a fever if any...And I don't trust that as the only sign of
infection from personal experience. Had I not taken her seriously, she could
have gotten very sick. So, do what you all do best, LISTEN to what the mom
is saying even though she may just say it in passing and sorta brush it off.
We are in a unique position to pick up on many things such as this one case.
She is on antibiotics and probiotics to replace the good flora. If this story
helps save one mom out there then this posting had done its job.
Thanks for reading this long post. And may this never happen to any of your
clients!
Best,
Robin
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