Hi again;

I am writting for help with a patient, with her consent, in hope of getting
some additonal ideas for this mom.

History:
23 year old
Gravida 1
Prenatal Care since 1st trimester
29 weeks gestation single birth
Maternal transport for city approx. 45-50 miles away.
Emergency C-section due to Sever Pre Eclampsia
No known history of thyroid, diabetes,heart or other health problems.  She
has good support at home.  Lives with mother.
No medications other than Prenatal Vitamins, according to chart, but mom
states her doctor put her on a "pink pill" for stress.  I asked her to find
out the name of the medication for futher evaluation. The doctor told her it
was safest and was aware of
    her desire to breastfeed after delivery.
Infant born with Respiratory distress, Prematurity and suspected sepsis.
Taken to NICU with uncomplicated history.
Infant currently in Progressive Care Unit doing well.  Off all oxygen and
taking enteric feedings by NG feeding tube and gaining wt..

Mom has pumped faithfully since 2 days post partum.  She states she
"initially had fuller breast, pumping approx.
    1-1/2 oz. per feeding".
Infant is now 3 weeks +4 days.  I had 1st contact with mom, one week ago
whem infant was assigned to me as patient in
    unit.  ( I am currently functing as a RN in the unit).  Mom was given
NICU breastfeeding material and reviewed pumping,     relaxation techniques,
nutirition and emotional support.  Mom at that time was getting only 5cc
total at each pumping.  She     does not see overly stressed or tired
(considering infant in NICU).

Spoke to mom yesterday  (Thursday) and supply continues to decrease even
with every 2-3 hour pumping.  She had obtained
    an Ameda electric pump for local WIC office shortly after discharge home
at 4-5 days.  She states that" I did much better     when I was in the
hosptial with the other pump (Medla lactena).  It felt much stronger suction
and I don't have to crank it
    up so high".

On Thursday I reviewed what she had been doing, pumping rest, diet,
relaxation techniques fluids and general health.. After assessing her
breasts I found sufficient nipple openings and easily expressed (hand)
breast milk dropplets.  Breasts are average (B cup) size, soft, with no
tender areas and only slightly palpatable breast lobes and no excessive
fullness at lactiferous sinuses.

I suggested that she use the hospital's pump on unit and compare milk
production/ removal.  Have her pump assessed for
    malfunction and contact her doctor for prescription for "Reglan".
Reviewed infant status to relieve concerns and
    encouraged her to "Kangaroo" when possible.

I am off for the next few days (work part time).  I requested mom's
permission to post to Lactnet in hopes of getting any other suggestions from
our members.  I plan to call the unit and check on moms progress.  Since I
am not hired in the LC capasicty I can not call her do a more extensive
follow-up.

I am really in need of any suggestions that you may have.  I am sure there
is something that I am missing.  Please contact me ASAP privately or through
Lactnet message.  I don't want this mom to think she is without help.

Thank You
Ann Slaughter  RNC, IBCLC

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html