Dear Lactnetters,

With her permission, we post this mother's situation to you. Not sure
we're getting the whole story, nor can we be sure how much the MD's have.
Some red flags appear, but nevertheless, we think this mom deserves a
purple heart!

No choice in  medical care due to her husband's occupation, second
opinion necessarily within same facility. Both MD's female, which
probably rules out at least sexism.  Recently stated she feels they are
"making her out to be a negligent mom".

She has a mild case of CP effecting one of her hands in such things as
writing and opening jar lids.  High school diploma, with history of LD
classes in elementary years. Social worker involved in consultations with
MD's and facility's LC, due to 2 reports with first child on negligent
housekeeping(?). Children appear reasonably neat, clean and well cared
for when she comes for WIC. The baby looks to be in fine health and
developmentally on task, and has never been ill.

Both parents of small to medium build. (Mom says each parent gained
slowly.) 1st child, now 2 y.o., totally bottle fed, gained weight slowly.
2nd child exclusively BF to start.  B.W.  7# 12 oz. At 2 month checkup,
wt. was RECORDED  as 12#.

At that time, she called us, concerned about getting only 4 ounces when
she pumped, as compared to 6-8 ounces earlier. Baby was said to be eating
only q. 4-5 hrs. and refusing breast if offered more frequently. Couple
was moving into larger apartment.  May have been missing feeding cues due
to stress of moving. Encouraged to watch for cues and feed oftener.

At the three month checkup,  wt. was RECORDED as 10# 6 oz.  MD was of
course concerned, and took the mom's report of "the baby having trouble
feeding" to mean that the mother was not producing enough, and discussed
concerns of FTT with her, speaking seriously about the danger of brain
damage. An electrolyte level was done at that time, but no further
diagnostic testing has ever been done to R/O other reasons for SWG. MD
strongly advised her to feed supplement after every feeding, and
suggested she might have to supplement indefinitely.

The mother called us, upset because she did not want to supplement but
frightened not to. Clear maternal and infant signs of overabundant milk
supply. Reported using a box of 60 leakage pads each week (mostly
hindmilk, no doubt). Baby's "trouble with feeding" seemed to be coping
with a very strong MER and gassiness.

We gave reassurance and suggestions for balancing supply and demand. Told
her we could not advise her to ignore MD's advice to supplement but
arranged twice weekly weight checks until baby started gaining and she
could negotiate at least pumped milk as a p.c.  At WIC 2 weeks later,
infant weighed 11# 12 oz. and was 23" long.

Infant was seen regurgitating several times during one WIC visit.  She
had never mentioned this to us. Reportedly mentioned it to MD earlier,
but states nothing advised at that time because baby had been gaining.
Gave information on G.E.reflux  and urged her to discuss this with MD
again.  Positioning, latch, MER and milk transfer were observed and
recorded as excellent.

MD continued to be unhappy with weight gain, reportedly began telling mom
her milk "not rich enough". Began to use the word "non-compliant" because
she had forgotten to bring feeding log and was mostly just breastfeeding,
not giving a supplement after each and every feeding. Baby was unhappy
taking a bottle from mom, but husband only home for evening/night
feedings.

MD refuses to consider family Hx of SWG, and refused mom's request for
copy of 1st child's wt/ht record, stating it was irrelevant - that each
baby is different. Second opinion MD reportedly told her some mothers DO
have too few calories in their milk- she KNEW, because it happened to
HER. They then gave directions to supplement with 6 oz. (!) after EVERY
feeding or give 1/2 scoop of powdered formula in pumped breastmilk at
feedings.

We advised her not to antagonize MD, but quietly express her desire to
continue BF for emotional and immunity benefits. MD reportedly said
"Bonding will happen anyway." We encouraged her to attend LLL meeting for
info and support.

The accuracy of recorded weights is a big question in our minds, and we
told her so. Subsequent diaperclad weights at WIC immediately before
medical visits at times differed by as much as 6 oz. or more. MD told her
she didn't CARE what WIC scales (checked yearly by County Division of
Weights and Measures) said. Only the facility's weight would be
considered.

On one MD visit,  weight was recorded as 12#. Next day when being seen
for a second opinion at the same facility, weight was recorded as 11#,
until the mother spoke up and insisted it be rechecked. The personnel had
misread the scale!

Situation went from bad to worse. MD totally forbade her to breastfeed
because of wt.  Reportedly made couple sign a contract to keep a feeding
log and another contract not to breastfeed. She pumped and froze her
milk, formula fed each feeding, but nursed occasionally for comfort.

At next visit, states MD angry over comfort nursing and made her sign a
second contract not to breastfeed AT ALL for 2 more weeks. Mom was
devastated and ready to give up and stop pumping, but called for support
because she still wants to BF.

Mom reports regurgitation has stopped now that she is putting rice cereal
in each bottle of formula. Did not say if this was advised by MD or just
started by client because baby is now 5 mo. Latest naked wt. at MD's is
12# 6 oz., 23 1/2 " long. At this visit, permission was given to BF for
comfort only, after formula at every feeding. MD wants baby to weigh 13#
at next checkup in a week.
Mother soon due to leave state for visit to (unsupportive) family, so was
provided with LLL # there.

We understand how MD and staff might have concerns about possible social
problems. But we believe that ABM, bottles, feeding logs, (and
intimidation) etc. only add actual risks,  and potentially more
complications to the situation of a mom with a toddler, a physical
handicap and a housekeeping problem. Accurate information and loving
support is what we have tried to offer.

Comments and suggestions welcome.

K. Jean Cotterman RNC, IBCLC
Dayton, Ohio

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