Elishiva,
I had hoped I explained this well enough, but realize I did not. Please see
below:
In a message dated 3/24/00 1:23:37 AM, [log in to unmask] writes:
<< Jennifer, since you say that the mother is "able to pump enough milk for
her
baby," why is it "clear" that the mom doesn't have enough of a milk supply?
It sounds like she has it, the pump is getting it out, but for some reason
the baby still isn't >>
While mom *can* pump enough, it is a rather long and arduous process for her.
It takes her 20 minutes of double-pumping, often *after* an attempted feeding
where the baby has stimulated the breast but not exhibited any swallowing or
effective suckling, just to get perhaps 2 or 3 ounces. While this is
certainly sufficient to feed a baby of 4 weeks, most mothers would find
themselves either pumping more in 20 minutes or decreasing to about 10
minutes to pump this amount. Now, in and of itself, this would still not
concern me, except that when I watch the baby nurse, I do not see *any* signs
of effective transfer.
<<-- that's why she's supplementing with milk pumped after
(and doesn't need to 'after a good feeding'). >>
I have never seen one of these "good feedings", BTW. The mother has described
them as happening about once per day, in the morning.
<< If that milk is in the breast
now waiting to be pumped out after a "not-so-good feeding" by the baby, why
do you feel "the baby would do well if mom's supply came up" even further?>>
Partly b/c the baby has been finger fed for almost 4 weeks and bottlefed once
per day for several weeks. Partly b/c the baby does show increased interest
w/ alternate massage. But, she never opens her eyes at the breast, there are
only brief moments of audible swallowing, she continues to be extremely
sleepy and fussy at the breast, while alert at other times. It reminds me of
the thread re: the study of cup vs bottlefeeding and "no" nipple
confusion--this baby, as Jack replied, would fit into the category of the
baby who did well despite the bottles or cup (or in this case finger feeds)
if her mother had a really abundant supply. Unfortunately, the mother will
not try a supplementer again and does not have an abundant supply.
<<All of this tends to suggest to me that the problem is still the baby's job
of getting the milk transferred better (thereby both feeding herself and
stimulating her mother), rather than the Reglan-related job of getting mom's
breasts to produce more.>>
I agree that problem still lies with the baby, but without a supplementer and
w/o the proper stimulation, the mother is losing the ground she gained w/ the
Reglan. She finds she is pumping somewhat less milk and her breasts have not
changed much in appearance from when she first started using the Reglan (at
which time the most she could pump was about 1/2 oz). Since the baby was not
latching at all when the mother started the Reglan and has only been latching
correctly for a few days, I think this is the worst time to go off the
Reglan. I thought that if we could keep the drug therapy in place now that
the baby knows how to latch, she may get some reward for her efforts and
begin to suckle better. If you have any other ideas about how to approach
this, mom is very open.
<<Jennifer - this seems to me to be a situation where a spot of weighing
might come in useful!
Not test weighing (!) but just weighing....like Elisheva, I don't know why
you think there is not enough milk for the baby, unless it's because the
baby seems unhappy at the breast (though as you say there may be other
reasons for this).>>
Heather,
See above, but she is not only fussy, but falls asleep soon after latching
and suckling for a brief time. She does have some brief gulping/swallowing,
but only very brief. The weighing would be an unclear test, since mom has not
gone more than about 18 hours w/o adding a supplement, as she sees immediate
decrease in output.
<<Chances are this baby and mother will gradually do better now the latch is
improving, though if the breasts are only being stimulated 6-7 times a day
she'll need more than that to build and maintain a supply.>>
My big concern is that the baby decreases wet diapers and has no poops at all
when mom just nurses. The 6-7X is pumping--mom is putting baby to breast
every time the baby wakes (2-3, rarely 4 hour intervals). She is exhausted,
as she has been doing this for 3 weeks and spends up to an hour working on
nursing and then still has to pump.
I would appreciate any help, as this mom has been very committed to this baby
in spite of much family opposition.
Jennifer Tow, IBCLC, CT, USA
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