In a message dated 5/3/2005 10:12:52 A.M. Mountain Daylight Time,
[log in to unmask] writes:
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Date: Tue, 3 May 2005 08:18:36 -0500
From: Kathy Eng <[log in to unmask]>
Subject: resend milk supply questions
What kind of pump is mom using and how often does she use it? Every 2 hours
means how many times in 24 hours? (Moms often tell me they pump every 3
hours but that really means 4-5 times in a whole 24 hour period.) Is she
sleeping all night without nursing or pumping? Ideally, she is on a rental
pump (or hospital grade) and someone has checked that her flanges are big
enough.
How many times in 24 hours is she really nursing? Every 3 hours would be 8
times if she is doing it in the nighttime. If she is skipping feedings here
and there or sleeping all night, this could be part of the problem.
What kind of childbirth? Induction? C-section? How long on the epidural?
Long epidurals make for sleepy babies who usually don't suckle well and
stimulate mom's supply. How many weeks was pregnancy at delivery?
Check her latch on for the chin smooshed into the breast and the nose going
out. More chin and lower lip onto the breast with the nose out. More bottom
areola into baby's mouth. Check for short tongue, tongue tie, etc.
Was she given Mag. Sulfate before or after delivery?
Is mom on any kind of chemical birth control method? (the pill, shot, patch,
ring, etc.)
What is baby's birth weight, lowest weight, and current weight? Hopefully
all weighed naked or in just a dry diaper.
How much formula is baby getting in 24 hours? Depending on how poorly baby
was doing weight wise before she started supplementing, too much in the
bottles and not enough breastfeeding can result in poor milk supply.
Test weights done at the breast would be extremely helpful to see what
amounts baby is taking in. Just because baby takes 2 ounces by bottle after
nursing doesn't necessarily tell us what we need to know. After nursing, I
would have mom pump on a hospital grade electric pump with large enough
flanges and see what she gets out.
I would like to see how baby takes an Avent bottle while sitting upright and
the bottle horizontal rather than vertical so gravity pushes the liquid into
his mouth. If he can not remove milk in this way, I would suspect something
in the baby's suck that isn't right. I would look at if baby's lips grip the
breast and bottle correctly, with wide open gape and flanged lips that have
muscle tone.
Good luck to this mom! Kathy Eng, BSW, IBCLC
Kathy and Chris,
Thank you both so much for responding to my post. I have passed on the
information and suggestions you have shared with me to this mother. She sends
her thanks as well.
This mom was using the PNS and pumps if the baby doesn't nurse for two
hours, but last night when I spoke to her she said that he is nursing every hour
so she is not pumping much. I sent her the equation for figuring his intake
every 24 hours because she was concerned she was giving him too much formula.
She has been nursing and then supplementing and we discussed supplementing
half of a feed first and then putting him to breast to see if he is willing
to nurse longer before falling asleep at the breast. She is definitely not
sleeping all night without pumping and/or nursing. We have also discussed
using a SNS or Lactaid but mom was hesitant to do that until she had some
reassurance that things might improve. This woman is VERY committed to this process
but has received a lot of bad advice and discouraging comments from her
health care providers. Hopefully we can get her in contact with HCPs who care
about breastfeeding and her goals.
She was in labor 14 hours with an epidural at hour 8 of labor. Vaginal
delivery with no complications. She was 41 weeks. Mom is not on any meds or
birth control. His birth weight was 7 lbs even and she has not had a follow up
weight (peds appt. tomorrow) but seems to think he is gaining weight. He is
alert and active when awake, nurses readily and has no signs of dehydration.
I agree about pre and post feed weights. I will see if this can be
facilitated. Thank you for the suggestions re: positioning during a bottle feed. We
will definitely try this and see how that goes.
For some reason, just a hunch, I tend to think that this mom does have a
hormonal imbalance that is preventing her from going through lactogenisis II.
It would be nice if her OB had asked her about breast changes during pregnancy
prior to delivery or was willing to run the lab work for her now. I know
another OB who would run the labs for her if she chooses to do that.
It is so frustrating to work against the very people who are supposed to be
working with us in the same directions, toward the same goal...especially in
light of all the medical evidence that supports what this mother wants and
nothing supports the doctors and nurses position!!
Thanks for the information and suggestions.
Sincerely,
Christie Pillado
El Paso, TX
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