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Subject:
From:
ANN G CAGIGAS <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 14 Jul 1997 22:00:15 -0700
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Hi fellow Netters, it's 6 weeks since surgery and today I saw my first
client.  Nothing simple, in fact I need help. I have searched the
archives and nothing directly addresses this problem. Sorry for the
length.
 This woman was diagnosed with Lupus 3 years ago.  She has been
asymptomatic and became pregnant, she was on no meds at this time.  She
was put on 60 mg/d of prednisone throughout the pregnancy.  She gave
birth at 32 weeks due to ruptured membranes.  She was fine throughout the
pregnancy.  She was not able to attempt BF immediately but began pumping
within hours after birth. She has religiously pumped 8x/24 hr and at 6
weeks pp she is only getting gtts(drops).  Her MD is weaning her off the
prednisone, she is at 30mg as of today and will be decreased to 20
tomorrow.  She is on no other meds.
 Baby has not BF, will occassionally L/O and suck infrequently.  She is
being gavage fed.  Mother is trying to feed with a NUK but baby falls
asleep after 5 minutes and experiences multiple episodes of bradycardia.
She has tried to BF while gavaging(smart Mom) to get the baby to feel and
hopefully associate fullness with sucking.  In 2 days of finger feeding
the baby refused to L/O at ALL.  She has not really developed a suck,
swallow, breath response.  She is 38 weeks gestationally today.  She is
to be evaluated by special services this week.  The baby is apnic, has
episodes of bradycardia, reflux and has Smith-Lemli Optiz Syndrome.  She
does not process cholesterol.  Developmentally I'd place her at 36 to 38
weeks.  I have put her on the haberman with occassional finger feeds, BF
while gavage feeding and suck training. During the consult we attempted
to feed her with the haberman and she would not suck.
 My gut feeling is that we need to find out why this Mom is not producing
and get this baby sucking and swallowing before we take any futher
measures.  I have recommended a baseline prolactin level, she has started
on fenugreek tea and will continue with the pumping. She was a client of
mine 7 years ago and had no problems with milk supply. She is not adverse
to using the SNS, as she used it short-term with her first baby, but I
don't believe it's appropriate at this time.   The breasts did change in
size during pregnancy, no fullness until 2 weeks pp, and the breasts are
fairly smooth throughout.
        So, any suggestions???  TIA,  Ann

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