Dear Jennifer,

I think that your concerns about her breasts before implants are well taken - it it something that is sometimes overlooked in moms with implants.  Pumping and galactogogues sounds like a good plan.  But I am wondering about a few things.

How jaundiced is the baby now?  If it was indeed caused by an ABO incompatability, the levels can get quite high, especially if the baby is also not eating much.  This will add to the lethargy.

How much is this baby getting to eat each day?  What is the weight at this time?  Trying to limit the amount of formula supplementation if the baby is not getting much breastmilk is self-defeating - the baby will continue to be lethargic with a poor suck until the calorie consumption is adequate.  Feeding a baby at breast with an SNS does not accomplish much if the baby is not sucking properly or strongly enough.  My feeling is that if you are going to supp w/ formula to get a baby going, you might as well give the baby what he really needs - the sooner the baby is awake and sucking, the sooner you can get the milk supply going and baby at breast effectively, the sooner you can get him off the formula completely.

It is too bad that the mom is uncomfortable with the chiropractor since it seemed to help.  Massage sounds like a good alternative route.  Mom needs to continue with the pumping.  She and her baby may just be late starters.  Make sure that the baby is adequately fed and try to keep the mom going - a week seems like a year to a new mom with problems and they reach the point where they think that common sense says its time to throw in the towel - getting them past that is often the turning point.  Let us know if the goat's rue seemed to make a difference.  Unfortunately, it is possible that there is a physical component here - but it is too soon to pinpoint that as a major issue.




Warmly,
Sharon Knorr, BSMT, ASCP, IBCLC
Newark, NY (near Rochester on Lake Ontario)
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