Hi to all,
I need some ideas! I saw a mother today who is nursing her 16 day old infant.
The M.D. sent her over  to our office as he didn't know what else to do.
Mother gave a history of having a non complicated  vaginal birth with out any
problems after delivery either. The mother says the baby had been frantic even
though the mother breastfeed this infant every 1-1 1/2 hours. The baby had very
few wet (cloth)diapers,1-2 per day after day 4. The baby  was sl.  jaundiced so
M. D. said to feed every hour. The mother was giving the baby some formula at
about day 4 when the wet diapers decreased.But the Ped said to stop the formula.
This mom did not deliver at our hospital so today was the first time I saw her
or heard about her.
Well,I weighted the baby and the baby breast fed for 20 minutes without me
hearing any swallowing . I then  weighted the baby again   and the weight had
not changed so I put the baby back on the breast and pumped the other breast as
the baby was suckling. After another  20 minutes  I had maybe 6 drops around the
flange of the pump. I weighed the baby again and the baby's weight had changed
by only  4 gms.Now I am using the Medela scale so I feel confident with the
weights. The baby has been losing weight, not surprising huh. The ped had  said
to give the baby pedialyte to keep the baby hydrated until the milk came in..
I did a digital suck exam and baby has  a good suck etc. Mother had also used an
SNS with the formula.
So what  did I do in the end! Well I  suggested the mother continue to
breastfeed for 20 minutes each breast on demand or at least  Q  1-3 hrs. and
then give formula. I am going to follow her by phone daily and have her come
back next Friday to reassess  the milk production or lack thereof. I will then
have hopefully heard from some of my  friends here on the net. At that time I
told her if her milk  is not in, she may just want to nurse for comfort and give
formula via SNS or what ever way she wants to feed.
This mother is an R.N. The mother said she did not see any real breast changes
during her pregnancy. She is not taking any medication. The mother has not  felt
any engorgement but she was leaking when I saw her today and  said she has been
leaking since the baby was born.    She also said her mother and grandmother
were not able to breastfeed either as they did not have any milk. I found this
interesting as she is Asian, and so her  mother and grandmother may not have
have had the "handyness of formula" like here in the U.S. of A.  to ruin
breastfeeding. So these women may truly not produce milk for what ever reason.
So she may be one of those"pesky 5%"!!  What do you all think?
Jan Aken Rn IBCLC from the NW where we had snow today to cover the ground.
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