Hi everyone - I've come across a really frustrating case and would love to have someone tell me what I'm overlooking!  I was called by a mom minutes before going home from the hospital with her 4 day old infant.  Her baby (girl) was born at 37 2/7 weeks, c-sx secondary to breech.  This is her first baby.  Mom is small (4/11").  She is 41 years old.  Her baby was born at 5 pounds 13 ounces.  Discharge weight on day of life 4 was 5-2. I was called for a consult because this previously very easy to feed baby suddenly refused the breast just hours before discharge.  LC's in the hospital were unable to get the baby latched.  She would become fussy at the breast.  I suspected that maybe mom was becoming engorged and that the change in anatomy affected the baby's ability to get on, causing frustration.  But there was no sign of engorgement when I did my consult that evening.  Probably by stroke of luck, I got the baby to latch easily, and in 40 minutes she transferred 0.6 oz. I couldn't explain why she refused in the hospital:  I was just relieved that she latched, which, was, I thought, the primary problem.  
I went back the next day, weight was 5-2 with no  breast refusal - latch on was easy.  She transferred 0.5 oz in 30 minutes, easily taking to both breasts.  She made very loud, gulping noises frequently while on the breast:  it sounded like she had taken a quart so I was glad I had my test weigh scale there.  She was stooling brownish-yellow stools 5x/day. Lots of urine.  I really thought there was just a delay in terms of her putting the weight on.  Sometimes it seems like the scale doesn't give a better number until things have been going well for a couple of days.  THINGS LOOKED PERFECT AT THE BREAST.  Tongue down, lips flanged, swallowing, gulp gulp gulp.  Next day, 5-2 again.  So, I thought she's hit bottom and will be on the increase tomorrow.  I thought "she's done losing weight".  Mom still didn't feel really full - maybe, I thought, because she's feeding so frequently.  Next day, ( day of life nine) 5-0.  Sleepy at the breast. Very difficult to wake up and get on.  Not transferring any milk because she won't even go in the restaurant!  RED ALERT!  I recommended pumping w/a double electric rental pump that she had, both breasts simultaneously 9 times/day for 15 minutes/session.  I recommended first attempting to latch - only try for 5 minutes, if no interest from the baby, pump and supplement EBM + formula to total 2 ounces with periodontal syringe.  Next day, very sleepy per mom on phone, couldn't get her to latch on - mom worried she was refusing breast because "the syring is so easy for her."  I reassured mom that once she was stronger and better nourished/hydrated, she would have the energy to breastfeed again.  This refusal seemed like a lack of energy kind of refusal.  That evening (day ten) (yes - I've been there everyday for now the 6th day in a row) she was sleepy but easily aroused and eventually latched on (took 15 minutes of waking her, stimulating her) She gulped and gulped and went from 5-3.6-5-4.2 in 40 minutes.  4 ounces of gain in 124 hours!!! So, I think ....baby's stronger, just needs some stimulation to wake her up....mom's milk should be coming in from pumping past 24 hours - recommended that she go down to 1 ounce of supplement after each breastfeed so that baby won't be so fat and happy and sleeping that she'll not be interested in eating.  I just rechecked her (day 11)......weight now down to 5-2!!!!!  Same as at discharge - and she's pumping and supplementing to beat the band!!!!! During the visit, baby latched onto left breast for 20 minutes with very loud frequent swallows.  I simultaneously pumped her right breast for 15 minutes.  Baby transferred 0.3 oz and I pumped 10cc.  Put baby on right breast for 15 minutes, transferred 0.1 oz - I simultaneously pumped left breast - got 5ml.  WHERE's THE MILK!!!!!!!  She's been on fenugreek and blessed thistle for 2 days.  NOW WHAT!!!!!  I would love some advice!  No history of breast surgery; doesn't smoke; is on no meds; has been under a lot of stress as their family dog had to be euthanized yesterday (bit nephew last week); no excessive vaginal bleeding.  what am I missing...or not doing???????
thanks.....janna in hot, humid central connecticut.  with no central air.  

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html