I want to thank all of you for your wiseness and kindness and excellent
help about the mother I have posted about with the terrible case of edema
and engorgment.
Update: Mother reported the baby nursed "nonstop" for about 18 hours after
I left. (Hitting his 7 day growth spurt, just having learned how to feed
effectively, and learning the breast was a pretty cool thing...who wouldn't
nurse a lot?) "But, when will I sleep?" she asked me. "During the nursings,
and after the spurt." I replied. After consoling her panic, and explaining
the mecahincs and time limits of the growth spurt again, we agreed to
reconvene and to weigh the baby Thursday (today.) She reported her breasts
were "Much softer and not at all painful."
No call today. When I called this afternoon mother expressed that they
were "not too good." I felt not only a weight check, but a follow up was in
order (I really like to do not only do weight checks, but actual feeding
observation follow ups with situations like this.) She said her breasts
were soft (YAY!) and that she was pretty sure her ankles and hands and face
were no longer puffed. Evidenly she is sleeping again. The baby had a nice
3 hour stretch at the end of the spurt.
Then I was told she had only fed the baby at breast 3X since midnight. "I
don't have any more milk." She was discouraged that she couldn't pump,
although we had gone through explainations that pumping (and a suggestion
to only pump if the engorgement was still evident, which was resolved at
this point,) especially with a PNS,or with any pump, pumping would NOT tell
her "how much the baby was getting." and that the baby would be the best
way to bring up her supply. I got no definitive answer about diapers. She
forgot to count, but "thought" she saw a dry one. (earlier in the
conversation she had mentioned 3 stools since midnight...) I explained
again, that soft breasts are normal at this point, and that being rock hard
engorged is NOT an indication of "good milk supply." I kept stressing how
normal things were becoming and that all the things she was experincing
were normal at this point.
She declined a weight check, saying the doctor would weigh him Friday. I
stressed again that the doctor has a different scale than I do, so weight
comparisons from his scale and the weights we got on Tuesday wouldn't tell
them much about actual intake.
This baby transfered 4 oz while I sat there Tuesday. He was feeding
*effectively* and was well on his way to overcoming a pretty bad oral
aversion when I left on Tuesday. She has been through the ringer, with the
very stressful birth, ect. I empathize with her anxiety. She said he
is "only attached to the nipple" (although she said that during the
consultation while I was watching, three inches away, and his latch was
excellent and she was not in any pain.) We went through the steps to proper
latch again. She suggested that she just "pump and put it in the
bottle." "That way I can see how much he is getting."
I feel we are at square one, minus the actual physical breastfeeding
problem.....
She now wants to eliminate the shield. We agreed that if he would latch
that would be great. Again, I said a follow up consultation would be very
helpful, so I can help with theirlearning to nurse on the bare breast and
help her feel more comfortable with "not seeing what he is getting." (She
was given oral and written "How to tell if baby is gettting enough milk"
data.) I also made it clear that if he wasn't on the breast a hospital
quality pump would really be neccesary to keep up her supply, as she
indicated she wanted to feed him her milk. (This was mentioned, several
times, at the original consultation.) One more thing, an unusual response
to his transfer of all that milk on Tuesday. Her mother started to cry, her
dh clapped his hands, the baby was elated. I saw her face when I read the
weight, and saw her pre weigh frown deepen. I discounted it as exhaustion
then. It may well have been.
Sometimes you feel you did all you can. The original problem was on the way
to resolution. All signs point to normal. You agree to adress any NEW
problems. And then she wants to quit. I told I would be there for her. It
is all I can do.
I am still hopeful that the baby will teach her that this is really a good,
normal thing, that *can* be done. He's a strong, healthy baby, and he could
well do that, if she gives him the chance to do it. I just don't know, in
her state, how much info is being absorbed. Maybe the baby has to be the
one to teach her the Way.
We can't want it to work out more than the mother does. That is my mantra
today...
I'll keep you updated. I appreciate the info and support immensely!
Mary Jozwiak IBCLC, RLC
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