Dear Friends:
Yesterday, I was called in for a consult for a mother who had received
so much intravenous fluid that she went into congestive heart failure and had
to be put into ICU. Her lungs filled up with fluid. She has memories of
vomiting on the table during her cesarean section. She is a first time mother; her
induction failed. (The literature has discovered that first-time pregnant
women being induced have a 1 in 2-3 risk of cesarean section.)
Naturally, with such a disruption, breastfeeding is not established.
Her baby is a week old. The mother was amazed to notice how much calmer
the baby was after a long spell of skin-to-skin; she did latch some but
became furious at the lack of flow and wouldn't sustain.
The mother likes the new pumping schedule; I have suggested that it is
better to pump for 5 minutes every hour than 15 minutes every 3 hours; which
is more like a newborn would feed. As the literature describes that newborn
babies nurse about 150 minutes in 24 hours, I have suggested she move the pump
to where she will spend most of her time and pump a little every time she
thinks of her baby. This is more of a natural schedule. This mother's supply is
presently low, although her breasts went from a A to a C cup during this
first week. I am guessing, based on evidence, that the stress of the induction
and congestive heart failure, has delayed lactogenesis II.
(A note for Jean Cotterman and others: there was no areolar edema that I
could feel; although her feet were still +1. Maybe the intravenous diuretics
prevented this from ocurring? This woman must have received enormous
quantities of fluid; she is 6 feet tall and weighed over 200 pounds at the end of
her pregnancy.)
During the visit, the father came home from work, and wanted to tend to
his baby. He changed the diaper and played with the baby and held the baby.
He was encouraged to stand in front of a mirror while he held his baby, so he
could see the baby's content face. He loved that!
The baby went to sleep after a while; the father went to put the baby
down. I suggested that he could still hold his baby during its sleep, that the
baby was sleeping inside the mother while she was moving, and that movement
wouldn't disturb the baby at all. This father loved that, and continued to
cuddle his baby.
Seeing that made me realize that it is a common response to put babies
down when they are sleeping; this is not necessary.
warmly,
Nikki Lee RN, MS, Mother of 2, IBCLC, CCE
Maternal-Child Adjunct Faculty Union Institute and University
Film Reviews Editor, Journal of Human Lactation
Support the WHO Code and the Mother-Friendly Childbirth Initiative
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