Annette
Thanks for the case history about ped scaring mom about starving the
baby..... you mention that the infant has lost 13 oz since
birth. But what was the birthweight - ie what percentage of
birthweight was this loss?? And what is the baby's weight now?
Meanwhile, good for momma that she wants to EBF. My protocol in
situations with possible inadequate breastmilk production, or
faltering rate of gain is:
1. Breastfeed with breast compression between sucking bursts to
facilitate drainage.
2. When swallowing stops switch breasts - presumably the hypoplastic
breast is producing a little milk? If so, drain it, if not then
suggest mom BF unilaterally.
3. Stop BF when swallowing stops - don't nurse longer than about
15-20 minutes unless there is still active swallowing. It wastes
time/effort to go on longer in a low gain scenario.
4. Straight after nursing, offer supplement based on baby's weight,
at 16 days baby would be taking 180ml/kg/day divided into, say 8
feeds, and you'd calculate how much s/he needs based on the rate of
loss or gain since Day 3, (usually the day the lowest weight should
have been recorded). Use any EBM available first, then if necessary
top up with ABM.
5. Settle baby (can use breast for this, allowing flutter-sucking
until baby falls asleep)
6. ASAP after nursing hand express or pump both breasts until milk
is only produced in creamy drops - again take no longer than about 15
minutes max to do this. Reserve EBM to feed first as next
supplement. Over time, excellent breast drainage will maximize
breastmilk production - either so that the baby can drink it direct,
or that mom can express it and use as a supplement, thus reducing the
amout of ABM required.
7. Rest.
8. Start BF/supplement/express cycle again after 3 hours.
9. I'd agree with you to explore use of domperidone, but not
metoclopramide (Reglan) as nasty side effects. Ask doctor about
sulpiride instead, 50 mg 3 times/day.
10. Weigh baby fairly often to monitor progress until gaining
well. You're aiming for catch-up gain, and then gain at least
30g/day. If she gains more then reduce quantity of ABM supplements,
then EBM supplements. Don't reduce by more than about 30ml/day until
you're sure that baby is doing well.
11. Mom needs lots of praise and encouragement for all this effort,
and the knowledge that she is maximizing breastmilk production, ie
doing the best she can and who can ask for more?
Pamela Morrison IBCLC
Rustington, England
---------------------------------------------------------
Momma, G7 P1, pregnancy on first IVF implant, hypoplastic right
breast, large space between breasts.
Infant born at 40.6 with no problems. Now 16 days old. Infant has
lost 13 oz since birth and has had several supplements of
formula. Momma is at a point where she only wants to feed BM and EBM
but Ped keeps "scaring" mom with FTT and "starving the baby".
Last night and today Momma has weighed, BF, weighed and then
supplemented donor EBM. Momma is wanting to request Reglan. I
encouraged to research side effects of Reglan and Domperidone medication.
Please share with me any suggestions, positive experiences and advice.
Thank you so much,
Annette Mueller
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