Sharone, this is indeed a challenging situation, poor mom!

Much of this case is beyond my abilities/training, however, I will tell
you that there is very little that can be done to help the baby without
first addressing the needs of the mother.  Until she has the appropriate
care plan in place and working, she is unlikely to do any better with
the children.

Medical intervention does seem indicated, mom may be suffering from
either postpartum depression or bipolar disorder (or other dx).  As I'm
sure you know, if left untreated, either of these dx can have tragic
consequences.  Perhaps it's time for a "changing of the guard" with her
health care providers.  A new face with a fresh approach may be able to
gain mom's trust and compliance.

I urge haste. While mom's threat to mix drugs may be call for help, it
must be taken very seriously as a possible suicide threat.  Perhaps the
best short term approach might be for mom to be hospitalized in order to
get close supervision on her treatment and medications.  Of course, we
hope for a patient advocate, such as yourself, who can help keep the
mother/baby dyad in the picture along with maintaining the nursing
relationship.

You haven't mentioned the father.  Is he involved?  Can arrangements be
made for a trusted relative/friend to care for the children until this
situation is under control?

Bless you for the compassion and perseverance you have for this mom and
her family, she is very fortunate to have you.
--

Denny Rice, RN, IBCLC
Dallas Texas USA

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