Been working with a mom for two weeks who has been a challenge. She is most
committed to breastfeeding as is her husband, so I too am committed to
helping her to whatever extent I can. She presents with very small breasts, at
least four fingers of mine rested comfortably between them so I suspected
insufficient glandular tissue and she reported no real changes in pregnancy except
for more prominent veins. Full term baby was nearly dehydrated when I met
them on day three which was quite alarming -- brick dust urine and dry stools.
They had called docs and hospital during the night before and were
sufficiently alarmed so fortunately, when I got there, they although reluctant, were
willing to begin supplementing with formula by bottle. Mom also said that she
had had thyroid problems but had not been taking her Synthroid regularly and
did not know if it was the correct dose. She went to doc promptly to get
that corrected. I also tried supplementing the baby at breast with tube feed
which worked okay, not great because of lack of breast tissue actually. The
tubing is so much more prominant and unyielding when there is not much tissue
to sink into. Over the next several days they began a regimen of of skin to
skin, formula feeds by bottle, formula supplementation at breast when she
could manage it and pumping post feeds. Switched her to a Symphony early on and
also got her on More Milk Plus Special Blend. Cannot take Reglan cause of
history of depression. Amazingly now at less than two weeks she is in fact past
her birth weight with almost all her nutrition -- breastmilk!! But,
parents are still terrified to change anything -- so mom is doing it all --
breastfeeding some with SNS/some without, pumping, offering "chaser" bottle usually
with mostly breastmilk but sometimes with formula. She is nearing the end
of her rope. Yesterday, I suggested that they begin weaning slowly from the
bottles, but she says that baby still takes an ounce or two post some feeds
and baby fusses at the breast as it empties. When she uses the pump, same deal
- quick response and let down for afew minutes, then nothing. Although, she
reports gettiing up to 2-3 oz at some pumpings, she is also afraid that she
will not have enough for the baby.
With her permission, I post today's email from her...
<<
Yesterday and today, her daytime feedings seemed to go
well. She's at the breast 20 - 40 min and gives signs
of being content when she's done. During the day,
she's received no bottle feedings. However, yesterday
evening and tonight, she's had these marathon,
frenetic feeding sessions. Here's her pattern
tonight:
5pm - 6pm -- one hour at breast (including time out
for burping). I've been stopping breast time at the
1hour mark, before we get overly tired and frustrated.
At the end of the hour, rather than seeming relaxed,
she was fidgity and fussy -- wanting to suckle.
7pm to 7:45pm -- 50ml breast milk from bottle. I
pumped some during this time -- maybe 30 ml.
8:00 - 8:30 -- 15 - 20min at breast. My supply seemed
low and she was pretty fussy the whole time, never
relaxed or suckling continuously for more than 30 - 60
secs.
8:50 -- Greg is currently giving her another ounce of
breast milk from the bottle. Greg thinks she may want
more.
So, she's been feeding off and on for over three
hours, was fussy at the breast, and has been taking a
decent amount from a bottle.
What are your thoughts on these night-time feeding
frenzies? I'm thinking that she may not be getting
enough during the day.
On a good note, she's had no formula today. I've had
enough pumped to meet her needs during the evening
feeding marathons.
Last night, after her feeding marathon, she slept well
and fed peacefully at the breast two times in the
night.
I can try the SNS tomorrow during a couple of her
daytime feedings, but I really feel like she and I
don't do as well with this system as when she's at the
breast alone.
OK -- she's just finished another ounce from the
bottle and is still fussy and fidgity -- I'm going to
try her at the breast again.
Let me know your thoughts.>>
I myself, am becoming confused with this situation and will be grateful to
you all for any suggestions you might have to give this mom the reassurance and
confidence to make some moves towards eliminating the parts that are
beginning to drive her crazy. She really hates the SNS, but I have encouraged her
to keep using it more and bottles less when they feel they must supplement.
When they bottle feed, I have instructed them to use paced feedings. I am
losing my pathway here and cannot seem to know where to go next with them...
Any suggestions? Thanks so much, Ann back from nomail
Ann Conlon-Smith, IBCLC Triangle Lactation Consultants
_www.trianglelactation.com_ (http://www.trianglelactation.com/)
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