Michelle writes about a complicated case involving retained placenta, loss
of substantial amounts of blood, and which has the additional complication
of issues on the baby side of the assessment ledger.  Since this baby is a
35 weeker, one has to assume weak suck.  In my opinion, feeding tube devices
require a normal ability to generate suction.  The typical 35 weeker can't
do this. The amount of milk transfer at breast with the feeding tube device
should be carefully evaluated with test weights before making any
assumptions about whether this is a good alternative feeding method for this
infant.  If test wts indicate that baby is just sleeping at breast with a
straw in his/her mouth, you may want to reconsider feeding method.  The tube
won't promote stronger sucking in this situation, and you still have to do
insurance pumping. Personally, I'd save the feeding tube for later when it
may assist in transitioning back to normal.

The milk supply should rise as the mother's energy and health improve,
providing the prolactin receptors (or whatever this mechanism is) are kept
switched on.  The pumping 8 times a day will do this.  Tell her to pump even
if nothing comes out.  It's discouraging, but the milk will eventually show
up (providing all the placenta has now been eliminated.)  She may never get
an engorgement phase.  The supply will just steadily build.  It could take
weeks for it to stabilize at normal levels.  Unless she can get donor milk
from a bank, she is probably forced to rely on formula.  Lots of
skin-to-skin care and comfort sucking will protect the baby's orientation at
the breast.  By the time the baby hits the real due date, the baby will be
more robust and able to breastfeed normally and the milk supply should be
coming back up.  She needs an iron-rich diet, lots of rest, and careful
assessment to make sure there is no infection suppressing milk production.

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com
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