The frustration of a mom whose milk is not fully meeting the needs of the
baby is often matched by my frustration in decsion-making:

1. (the easy part) evaluate feeding effectiveness, breast, mouth, etc....
BUT NOW - 

For example (this is not one case, but an example of repeated cases I have
had to deal with in the last year).

Baby is 2 weeks old.  Has not been breastfeeding effectively, and I have
now corrected positioning and taught moms breast compressions.
Mom was not instructed to breastfeed on cue - she was told to feed baby
every 3 hours, and to "complete" every feeding for the first three days
with 2 oz of formula (per Pediatrician's order). 

Baby is now taking 3 ounces at every feed, willing to stay at the breast
for 3-4 minutes, so I can switch to an SNS, have her pump/hand express
after feeds to increase production.

However, I'm finding that moms don't do this - they get frustrated with the
SNS, are too tired or busy with other kids  to pump/express after every
feeding.  Perhaps they'll do it 2-3 times a day if I'm lucky.

Physicians I've worked with have recommended the use of Reglan EARLY in
this process, which will raise prolactin levels closer to the time when it
would have naturally been up.  
But others of you recommend avoiding it at all costs and using fennugreek,
etc.

Could we have a discussion on this or has it been hashed over recently?

[I know I need to work on the hospital information and the MD information,
and in my current position I can work on it - but change of that nature is
slow and I need to help these moms NOW.]


Jeanette Panchula, BSW, RN, IBCLC
Vacaville, CA
mailto:[log in to unmask]

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