Permission to post:
 
I could use some opinions about this case.  This mother contacted me through
LLL and so I have only had sporadic contact with her.   Baby is losing
weight, or at least it appears that way (I do not have all the stats
yet...waiting on them from mother).  Here is what I know, in point form:
 
~baby born 11-19-06
~mom slightly anemic when pregnant
~traumatic birth
~midwife attended...planned for natural...ended up with epidural, pictocin,
2 shots of morphine
~mom and baby were separated for 4 hours post birth
~baby not put to breast until 4 hours old
~mother is unsure why she and baby were separated...does not know APGAR
scores or baby's respitory/health condition at birth
~mother's temp spiked to 40 degrees C during labour
~unsure of supplementation in hospital
~mother's milk came in on day 3
~paci used regularly from birth...possibility of missed feeding cues from
the start
~once discharged, exclusive bf/ding until about 4 weeks of age
~at about 4 weeks old, a bottle of formula was introduced at bedtime, as it
seemed to "calm baby and help her sleep"
~ mom's main concern was baby's fussiness and refusal of breast, which was
getting worse and worse each day, so much so that mom was 'resorting' to
bottle of formula after attempting nursings
~baby tends to stiffen, pull way...not arch back...just push at breast and
push with feet
~baby was frequently pulling off, coming back, bobbing, etc. at the breast,
and appeared frustrated with the whole bf process
~baby is very oral, with her hands to her mouth all the time, not just when
wanting to feed
~baby has small 'skin tag' on side of tongue  - looks like an enlarged gland
- not susepcted to interfere with bf/ding
~from about 4 weeks or so, baby sleeps 7 or 8 hours per night after the
bottle of formula (thereby mom not having her breasts stimulated for 10 or
more hours)
~mom has very minimal success with pumping or hand expression
~mom does not feel let downs
~mom does not report any primary low milk supply factors (such as reduction,
thyroid issues, hemorrhage, etc.)
~mom had seen countless hcp's about bf/ding before contacting me
~mom started domperidone two weeks ago...took it for 3 or 4 days
~mom dropped the bottle of formula and added one or two nursing sessions in
24 hours
~mom refined her latch, positioning, and began using breast compression to
keep baby at breast
~since refining things, baby behaves better at the breast and stays on for
longer, but still get frustrated when milk is not immediate
~baby no longer seems nipple confused, now that the bottle is gone
~mom 'switch nurses' from side to side in order to keep baby happy, with a
mouth full of milk
~last known weights:  Feb 13 = 10lb 9oz / Feb. 27 = 10lb 5 oz / same scale,
same time of day / indicates a 4oz LOSS over two weeks
~mother will have baby weighed again tomorrow...I suggest that if baby's
weight has declined further, or remained stagnant, that mother re-introduce
supplement using feeding tube on breast or syringe method
~mom back on dom (full dose), will add known herbs to complement dom
~mother reports feeling firmer since starting dom again and reports that
baby is staying longer on the breast before getting fussy
~mother takes evening primrose oil and St. John's wort
~baby gets no formula, and now wakes 1x per night for feeding
~baby still uses paci, but less often than before
~typical day is wake/feed at 6am; cat nap at 7:45am using paci; wake/feed at
8:15am; cat nap @ 10:00am using paci; wake/feed at 10:30am; cat nap at
12:30pm using paci; wake/feed at 2:00pm.
~baby does not nurse to sleep
~I have suggested chiropactic or CST.  Mother not keen on chiro, but will
consider CST.
 
So...do you think that the only thing we are dealing with here is low milk
supply, for whatever reason...or am I not seeing the forest for the trees?
Given the patterns, is adding dom and herbs enough for this baby, or should
supplements be added anyway?
 
PHNs and doctor do not seem to be overly concerned...but...I may only be
getting part of the information.  I have only seen this mother and baby
once, talked on the phone a couple of times and emailed.  Last contact
indicted everything was fine, until she contacted me again a few days ago.
 
Thanks for reading this far!
 
Karyn-grace Clarke, IBCLC, LLLL
Gabriola Island, BC

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