I have a current case that I would like some guidance with.  Mom was my
prenatal patient, but delivered by c-section at 34 weeks when she went into
labor and was breech presentation.  Baby was 2500 grams at birth, but had
respiratory distress syndrome and required oxygen for the first 3 days of
life.  We originally fed him by NG tube.  Once he was well enough, he went
to breast, but was unable to feed effectively.  He was basically unable to
move any milk, despite a pretty nice looking latch.  With a small shield, he
could transfer a little milk, but not enough to support growth.  He went
home being fed my bottle, mostly breastmilk.  Mom pumped from the beginning,
and is now making his needs, so he is getting only breastmilk.  Corrected
age is now about 35 weeks 4 days.  Baby shows interest in the breast and
latches, but still can't transfer enough milk.
The situation is complicated by the fact that this first time mom originally
during her pregnancy thought she wanted to pump and bottlefeed her milk.
Then she decided to at least start off breastfeeding, but she is nervous
about it.  Add in a poorly feeding, premature baby, and she doesn't have
much confidence that her baby will ever be able to breastfeed.
Can I expect this baby as he gets stronger to become more effective at the
breast?  Any words of wisdom to share with this mom to help her confidence?
 She is now putting him to breast at most feedings during the day, with a
small shield, then feeding him pumped milk by bottle.  Baby's weight gain is
good.
Jennifer Tieman
Family Physician
Mom to 4, including nursling Caroline Rose born 5/31/03

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