Wise Ones:

I'm currently working with a dyad that has me stumped.

Fourth baby, born at home after a normal labor.  Labor was somewhat longer
than expected but otherwise unremarkable.  The baby weighed over 8 lbs., as
did her siblings.  Siblings were all breastfed for over a year with no
problems.

She is now 17 days old and was admitted yesterday with a billi of 23 and some
apparent dehydration.  On IVs, billi lights and formula supplements.  Mom
says that even with a bottle, baby sucks and doesn't get milk out.  She does
fairly well with finger-feeds.

Milk appeared to come in on day 3, with the attendant signs that mother was
accustomed to.  However, baby has lost over 10% body weight at this point.
At breast yesterday, she appeared to be suckling correctly and took in 2 oz.
Since then, mother has pumped only 1 oz and less.  Today she says she feels
like "my body is weaning".  She's been taking More Milk for about 48 hrs.
Says diet and hydration are adequate.

Her placenta was described by the midwife as "bizarre".  It had a somewhat
"shredded" appearance.  Her lochia is scant at this point and there has not
been any heavy bleeding, fever, etc.

Since she did have some lactogenesis, and her bleeding is normal the midwife
doesn't believe that it could be placental fragment at fault.  It seems to me
that an U/S wouldn't be out of line, anyway.

To make all of this worse, her regular LC is out of town and I haven't seen
her chart.  I talked with the LC briefly.  She stated that suck assessment
seemed nl and that once the latched was deepened the baby looked good (2 days
ago).

Mom is exhausted with four small children.  No drugs, cigarettes, etc.  I
can't think of any other pertinent facts.

What are your thoughts?  Do you think it's possible that there is a placental
fragment in light of what I've shared?

Thanks for your insights!

Nancy Williams, MA, MFT, IBCLC, CCE

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