Dear Heather and all,
The use of the SNS, added pumping, etc. may not be just the
"American" way of dealing with the baby 5 oz. below discharge weight, but
the individual LC's way. I would not have added all those "extras" yet.
I think I would have checked the latch.....was baby deeply onto areola
effectively milking the lactiferous sinuses? Was baby spending a long
time on the first breast for the hindmilk? Was the baby's birth weight
"artificially inflated" with lots of IV fluids for mom during labor?
Examine baby's oral cavity....tight frenulum or questionable frenulum?
Maybe baby needs to be held closer to mom to get well onto sinuses, or
needs a deeper latch.
A few months ago a 3 week old infant was readmitted to our Peds unit
for otitis media and low weight gain. The mom had been nursing only 5-6
times per 24 hours. The baby was not demanding. Nipples were a little
sore and cracked, not too bad, but feedings were uncomfortable for mom.
I saw them a few hours after the admission on a Sunday morning. Mom's
milk was "right there" and easily manually expressed, breasts felt
moderately full. The baby had a tongue tie. The mom lived with an
abusive boyfriend (per staff nurses), and had a hx of depression,
divorced and does not have custody of six yo daughter, and no permanent
address. I thought if we adjusted the latch so it doesn't hurt the mom
would feed the baby more, if the MD clipped the frenulum it would/should
be more comfortable for mom and baby could get up on areola more and milk
the sinuses better. I encouraged the mom to feed baby q1-2-3 hours and
explained how crying is a late hunger cue and what the earlier hunger
cues are, also the normal I&O we hope to see for a breastfeeding infant.
I thought if I added pumping at this point the mom may not be able to
handle it, breastfeeding may seem "too hard" for her, and to wait and see
if these adjustments made a difference. The frenulum was clipped the next
day, a Monday, and feedings did feel better for this mom. In discussing
this case with one of the LCs I work with, she thought mom had low milk
supply.......... I read to her what happened during the 2-3 days since I
had seen the couplet.....baby was having 7-8 yellow stools, 8 wets per 24
hours, had gained 100 grams overnight, had 10 feeds at breast the past 24
hours. No abm supplements. The mom had been given an electric breast pump
by our LC staff the day after I saw them....the mom used it one time in 5
days!
I don't bring up this case as a source for argument, but as an
example of different styles and approaches. I'm beyond trying to "be
right", I just want what is beneficial for each patient. An older LC I
have since met works by the principle (which I also adhere to) to keep
things simple, if at all possible! And that often small adjustments can
be enough.
Didn't mean for this to be so long.......any comments?
Susan Potts Minnesota rn ibclc
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