Hi Rachel,
Just for the record, I did all the usual assessments on baby and yes she was a 
bit behind in fluids, it did resolve when I sent her home using sns  feeding q 2 -
3 hours with ABM 30 to 50 cc.  And once I corrected the latch baby could be 
seen swallowing which I always teach parents to notice before being 
discharged from hospital.  I didn't see her in the hospital.   1. Correct latch 
and positiong first, 2. get some food into baby so she had enough stamina to 
do some breastFEEDING instead of pretending to feed.3 Protect moms milk 
supply and once we got some food into this baby it reallly resolved on its own 
and pumping It was fabulous to see the turnaround the next day.  from 12cc 
to 70cc.   They also never saw the babies eyes open and that nice calm look 
from a well fed baby who just sits and looks at you, in the quiet alert state.  
Parents had never experienced this before.  I know you have seen the 
senereo a hundred times before.  Baby's eat and then go to sleep immediately 
reserving their calories and just shutting down.  If you would like more detail I 
am more than happy to send it out, again the main point was listening to 
moms and caregivers as we are in a unique setting to pick up on things that 
may not have a direct relationship to breasteeding.  And yes, I don't think for 
one minute the 4x4 really was hindering the supply, but i do think she was 
exhausted and her body wasn't healing as quickly as it could have.  She did 
have a dull pain and was nauseated at times.  I didn't go into detail about the 
baby, because my point was listening to mom and dad.  I told her (being a 
former L&D nurse) just about the same thing you said.  The MD is a good 
doctor and sometimes things get missed, i suppose it was "hidden" behind the 
fornix as you described.  This was just a gentle reminder for me to listen and I 
wanted to share this experience with you all as a gentle reminder for us all.  If 
you want more info on my plan of care please e-mail me off list as I didn't 
want to send a HUGE message.  

Best,
Robin

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