We are winning!  Baby gained 120gms in 2 days with vigorous supplementation of EBM.  She is now sleeping very well and  is catching up on her sleep (the baby that is).

This case has certainly been a big reminder of how multi-faceted most problems are!  Along with the baby's cardiac condition and slow weight gain was PND, lack of bonding, grief over the loss of the "ideal" baby, fear of all the stresses ahead (surgery etc), the demands of a two year old but most of all the woman's shattered vision of "ideal" breastfeeding which for her very much included  relaxed tandem feeding.

This mum now has to come to terms with "managed" breastfeeding (at least for now).  I did feel the big meanie shattering her dreams and saying "demand feeding will not work here".  So out came the scales for test weighing, out came the bottles and supplementers, out came the calculator to work out volume requirement and out came the clock!   The alternative to all this would have been hospital admission, tube feeding and then exposure to all those hospital infections!  Avoiding hospital admissions is definitely worth it.

The other factor I noted on several home visits was how much energy the baby was using with activity. Conserving calories is also about not using calories.  We are in the middle of summer here but the baby still needs skin to skin  and "nesting".  Very much like a prem baby I feel.

Thank you all again for your help.  I'm sure we have turned a corner.

Karen Palmer, Midwife, IBCLC
Waikato Breastfeeding Collective
New Zealand

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