Looking for guidance or reassurance...
I am working with a mother who had baby #2 on 8/5. He is now 2 1/2 weeks
old. Baby was born after a very long second stage (several hours of
pushing) and then a transport from the birth center to the local hospital.
Baby's heart was strong during labor and transport until delivery by vacuum.
Baby born blue...no heart rate, not breathing and was bagged in L&D until
someone from the ER could come up to intubate him. Three hours later (due
to broken helo) he was transported to the Children's Hospital where he was
on a ventilator for 2-3 days, in kidney and liver failure and unable to
regulate his BP. His EEG and CT scan showed moderate brain damage. He
received no nutrition for a few days, then IV feeds until he was almost 2
weeks old. He received EBM by bottle and first went to the breast on
Thursday (his 2 week b'day).
Baby was discharged from hospital yesterday, kidneys and BP normal, EEG and
CT normal but still having some liver stuff going on. He is very yellow and
is taking some kind of oral med to help flush the bili. Mom has been
pumping with a good pump since day 2 and has a decent stash of milk.
To complicate things, mom had big supply and FTT problems with baby #1 and
used an SNS for months. This was to be the baby who would "fix" the previous
bad experience.
Mom reports that baby has "normal" suck/swallow (per developmental ped at
hospital) and drank from the bottle well and quickly and nursed at the
breast well at the hospital. Now that he is not receiving any bottles, he
is also not interested in staying on the breast for very long.
I spent 2 1/2 hours with her today and watched this little guy nurse. First
of all, he has a HUGE swelling on the back of his head from the vacuum. It
is awful. Plus neck bruising from being yanked out. He has a nice wide
open mouth and good latch. He gets right on, sucks a couple of times,
swallows and then just sits there with his good latch and stares at his
mother. He mucked about for a long time doing this 2 sucks and sit there
and then he finally let go. It had been close to 4 hours since he had
nursed so I suggested cup feeding. He really didn't care for that so I
didn't persist.
We tried the SNS (mom is very experienced in using it). He latched on
beautifully, stayed on and took 1.5 oz in 10-15 minutes. He still had alot
of the long pauses in between sucks but clearly was being more efficient
then he was without the SNS.
My thought is that he is easily fatigued still from his traumatic birth, 2+
weeks in the NICU and his jaundice and he needs the jump start from the SNS.
Mom is getting a scale tomorrow to do tests weights. I know it is somewhat
controversial but she was planning to do this even while still pregnant due
to her previous FTT baby. She is afraid he will become "addicted" to the
SNS (like his brother did before him), but I think feeding at the breast
with the SNS is the lesser of the evils here. At least he is at the breast,
getting nourishment at the breast and not getting artificial nipples. We
can work on getting him off the SNS later.
I encouraged her to watch his output (2 poopy diapers while I was there), do
lots of skin to skin and even a rebirthing bath, feed him (even if it is 2
minutes out of every 10) and give herself and her baby some time to heal
from what happened. The fact that he is alive, let alone home, is
miraculous and perhaps they should treat today as day one in teaching him
how to be at the breast.
If you have lasted this long, thanks! I usually work with older babies, and
not seriously ill ones, so I am treading carefully here. On a good
note...baby was transferred from Children's to the big military hospital
after one week. Mom told me that she saw NO formula in the NICU, except for
milk fortifier for the tiny premies. She even talked with one mother who
was pumping even though she had not planned to do so. All the babies were
getting their mother's milk!
Thanks for any input or reassurance that I am on the right track.
Kathy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Kathy Koch, BSEd, IBCLC
Great Mills, MD
mailto:[log in to unmask]
"Children in a family are like flowers in a bouquet: there's always one
determined to face in an opposite direction from the way the arranger
desires."- Marcelene Cox
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