OK, my turn to verbally bite my fingernails on lactnet! Don't quite know
what I'm asking for, but I'm sweating over this one (and on my birthday,
too!)

Was very excited to get a referral from a doctor's office yesterday - those
little promo cards I sent around didn't all go right in the garbage! Anyway,
here's the story:

5 day old baby, not nursing at all since some rough handling by a nurse in
the hospital. Significant wt loss, some jaundice but not bad, no stools for
>36 hrs., only 3 wet diapers in past 24 hrs., scrawny little thing with poor
skin turgor, thin little fretful cry, very dry, very ketone-smelling, not
nursing at all, had had only 20ccs of ebm by cup in past 36 hrs. Nothing
else po. Since episode in hospital with the head-jamming nurse (and the poor
little head must have been sore from longhard labor (transverse) and
emergency C/S), baby averse to even the BFing position - screams, fights,
struggles, etc. Parents discouraged, didn't want to upset her, exhausted,
wanting very much to BF but apparently unaware of baby's increasing need to
eat (?!). Mom has very large breasts, full but not engorged, very (dare I
say it?) flat nips. (Complicated by painful back condition & arthritis,
aggravated by labor, surgery, & milk surge.)

So baby just not nursing or being fed. Sleeps long stretches (5 hrs. or
more) . Mom getting 50-60 ccs with manual pump, but hadn't been advised of
need for regular frequent expressing. So they'd fed once or twice by syringe
(just precious drops), and then once by cup, which they much preferred as it
was faster.

I had to really push them to get the baby up, even though it was > 6 hrs.
since the one significant fdg. (the 20 ccs) of the past 3 days. Fed ebm by
cup - I had to really push them to persist & get around 50 ccs in, but baby
took it well (best I've seen, in fact!), was very happy to get it & pleasant
while awake. Nothing doing with trying to get her to latch on & nurse,
though - exactly as parents described, she struggled and fought and screamed
and refused to have any part of it. So OK, I figure we'll feed her up with
ebm for now, work on making her find the whole situation more pleasant, and
once she's had a little food & gained some stamina (not to mention a few
ounces) we'll get her on the breast. Set mom up with a good electric pump,
made sure the parents understand the importance of feeding her regularly &
not letting her go more than 3 hrs., what we need to see in terms of
increasing output, blah, blah, blah. Skin-to-skin, bedding-in, comfort
measure for mom., all that stuff.

OK, so I worried all night, called today expecting to hear that at least
there was some peeing going on over there - but only 1 wet diaper, about 18
hours since I left them - they'd struggled with the cup feeding but hadn't
quite managed the # of fdgs I'd have liked, and now were worried 'cause
she's spitting up. Doesn't sound like a big amount, but you know how new
parents can be. So I suggested feeding the ebm by bottle (gasp!), to
facilitate it for them and get every possible bit into this starving little
baby. They sounded reluctant about this, but I *think* I managed to get
through to them that this was starting to be a pretty edgy situation & the
priority at this point has to be getting the milk into the baby. (Or use the
cup, I don't care, just *feed the baby*!)

But now I'm nervous! I will call 1st thing in AM, but what if they aren't
really together enough to really get that little squirt eating? I, as an
experienced nurse, am not really liking the thought of this baby being
un-eyeballed till tomorrow. Especially with the recent discussion of
lawsuits! I'm absolutely *not* a panic-button type, but the more I mull this
over the less happy I am.  This is the first worrisome situation I've had
since I've been in private practice, and I see that it's significantly
different - no one to fuss it over with, for one thing, no one to say
"sounds like it'll be OK till tomorrow" or "are you nuts? that baby needs to
be seen NOW!"

I'm so glad you all are out there - I'll think of you while I stare at the
ceiling all night worrying!

Cathy Bargar RN, IBCLC Ithaca NY