Hi Brooke,
I think you will know alot more once you see mom in person, here is a
case that really needs in person consultation.
I see (what I consider to be) many cases of low milk supply, related
to hypoplasia, but very often confounded by poor hospital practices
and prematurity etc. If mom truly has nipples too large for baby to
latch effectively, then that will factor in to your plan, like
possibly using a bottle til baby grows more.
I generally offer options and let mom choose. Some options would be:
Option 1. Use a lactation aid. I use the homemade version with #5 Fr
tubing, 36 inches long. Express after feeding either by hand or with
*hospital-grade* double pumping. Lots of STS, biological nurturing.
Bottle can be used at times if needs a break, if it's faster, or if
another person can feed the baby for mom to rest. I would recommend
galactagogues (I like More Milk Plus).
Option 2. Paced bottle feeding with slow-flow nipple, lots of STS and
bio nurturing. Express by hand or by pump as above. Galactagogues.
For either option, factor in the family's budget. In Mississippi,
families often do not have the finances to rent pumps. Often they
participate in WIC (program for low income families) and can get a
loaner. If not, they use the pump they have or can get. Encourage hand
expression too.
For either option, the feeding/expressing should not take too long. If
it takes 1 hr to feed baby with lact. aid, then 25 min to pump, that
is taking too long. So brainstorm with mom, as bottle feeding may be
more efficient, power pumping for 10 min but more times per day. Have
family or friends come over to make up formula bottles, the ebm can
sit out at room temp til next feed.
Make a list of what family needs and when folks call and ask, then go
to list -- we need you to run to grocery or can you cook a little
extra spaghetti sauce, etc? Often family wants to know what baby
needs, and I say he doesn't need a stroller or high chair yet, but he
needs a good pump, so maybe family can rent for 1 month.
Lots of emotional support, needless to say. I'm sure I'm not telling
you anything new. Basically mom needs help just to talk through what
she feels she can do, what might get her the best results, how she
might plan out her day and make time for food and rest for herself.
laurie
Laurie Wheeler RN MN IBCLC
Mississippi USA
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