Re: Barbara Whitehead's "Help!" baby -
Isn't it frustrating when you talk to someone on the phone, in a lot of
depth, but she "isn't sure" if she wants to "go that far" as to do a home
consult? If she isn't sure whether she wants to "push it" with the BFing,
and she rejects all your suggestions, and the SNS is "too strange", and
you've given her all the standard suggestions re: getting the baby to
breast, it seems to me that you've done your job, Barb! What more does she
want YOU to do, without her even committing to a visit?!
I don't know how you get paid for your services, but this is the kind of
thing I've become a little less tolerant about since I've been in private
practice. So she's got you (and now all of us!) spinning around in circles,
thinking about this little baby & how to "make" it nurse effectively and
grow, and you're probably spending just as much time thinking about it as if
you'd gone out to see them, and (if you're fee-for-service) you're not even
getting paid! I've learned, with clients like this, to make the best
suggestions I can over the phone (in a reasonable time - up to 45 minutes or
so), and tell them that if my suggestions didn't help, or they need more
in-depth, they'll need to make an appointment for a home visit.
When I worked at WIC, I'd do as much phone help as people seemed to want -
that was what I was being paid to do, and it didn't matter whether they
called me once & I told them to nurse more frequently (something that
happened about 10 times/day, and solved probably 80% of the problems)and
that was that, or whether I dropped everything and sped out to their house
on wings of lightening. I was a public servant, and I was there to serve.
Well, I'm still here to serve, but you gotta pay me! Is this cranky of me? I
just don't like working for free!
Cathy Bargar, RN, IBCLC Ithaca NY
-----Original Message-----
From: [log in to unmask] [mailto:[log in to unmask]]
Sent: Wednesday, April 07, 1999 11:04 PM
Subject: Help!
I am working by phone with a Mom (she doesn't know yet if she wants an
in-home consult because she doesn't know if she wants to go that far). Baby
is 4 weeks old. Was 3 weeks early, birthweight was 4lb, 14 0z, discharge
weight was 4lb 4oz. At 1 week was down to 4 lbs. Ped put baby on bottles of
formula for one week ( baby also had bottles of glucose in hospital). Baby
gained 11 oz. Ped then told Mom she could nurse after giving 2 oz of formula
by bottle evry 3 hrs. Mom has been pumping with a hospital grade pump this
whole time. Baby gained 9 oz the next week. Ped told Mom she could BF now.
Baby is floppy, and sleepy so Ped also referred baby to the hospital feeding
team ( OT and PT). They have done an assessment and by listening to the
baby's throat with a stethoscope while feeding a bottle, they told the Mom
the baby had a disorganized suck, and they didn't hear clicking which would
indicate swallowing. They told the Mom there was nutritive sucking and
non-nutritive sucking and the baby needed to do nutritive sucking so they
recommended pumping, giving only a bottle with breastmilk, and then at the
end of that, letting the baby do the non-nutritive suck at the breast. They
told the Mom this baby seemed to be developmentally delayed. Mom doesn't
know
how far to "push" BFing ( her word). I have discussed with her everything I
can think of, including discussing with the feeding team the use of the SNS
(
they felt this was too much for the baby to organize). Tonight I discussed
the Haberman feeder. The Mom used a disposable SNS in the hospital to
finger
feed after the baby had the glucose bottles and felt that was too strange.
Any thoughts?
Mom says the baby still is very sleepy and does seem to be very relaxed.
When
she tried to nurse last week the baby would fall asleep at the breast. When
she last BF, last week, she said the baby would nurse for 1 hr, but was
sleeping at the same time.
This Mom goes to the Ped office with the " BFing Friendly" attitude, as I
discussed last week ( their interpretation, not mine!).
Does anyone have any experience with a OT/PT feeding team? I suggested the
Mom ask them if they are experienced or educated with BFing but she felt
this
was not an appropriate question since the Ped referred her to this team.
I would appreciate any thoughts on this, suggestions that I have missed,
etc.
I have suggested pumping to soften the breast , using a SNS, and/or
Haberman,
and all the " routine" suggestions we make to get the baby back to the
breast.
So far in one week I have been working with this Mom and Baby; a 17 yr old
with a 9 day old that I have done 3 home visits with this weekend for nipple
confusion and jaundice; a Hispanic family with a 1 lb, 9 oz premie; a
Hispanic with flat nipples and 3 working Moms. I need a vacation!! I am the
only IBCLC in about a 15 county area. And in my spare time, I am doing an
internship in Community Health Education so I am doing my LC work after I
get
home at 6PM.
And to top it all off, Baseball seson started today, so I'll have 4-5 games
a
week until the end of June with my two sons! Wonder if I can ask the new
Moms
to meet me at the ballpark and do consults in the stands? Probably not a
good
idea!!!
Barbara Whitehead, IBCLC
Eastern NC
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