I am looking for ideas on how to help a young woman with
whom I have been working. I saw her once in the hospital
shortly before discharge and helped her with latch.
One week postpartum she attended the breastfeeding mothers'
group and I worked with her privately afterward. At that
point positioning and latch were poor and she had lost the
skin off the tips of both nipples. I taught her to hand
express and cup feed and she planned to rent a hospital
grade electric pump and cup feed for a couple days while her
nipples healed. I put her in contact with another
breastfeeding mother who had had sore nipples for an
extended period of time. She kept in contact with the other
mother, but did not contact me.
I saw her last Thursday at the group. Her nipples are still
raw, but clean. She said cup feeding didn't work well for
her, and she really didn't want to stop breastfeeding. She
was concerned about nipple confusion. She has been using
Jack Newman's APNO for 6 weeks, but sometimes only 3-4 times
a day. I again suggested nipple rest and told her we could
deal with the nipple confusion if it occurred.
She tried to do nipple rest, but says she can only express
2 oz. for a feeding--think she said it sometime took an hour
to get that much. She has no privacy for pumping or
expressing--lives with her brother who may walk in any
time. She says hand expressing works better than pumping
(Medela hand pump). She has been bottle feeding the 2 oz.
with a Medela nipple. Since the baby is still hungry after
the bottle, she goes ahead and nurses him on the least sore
breast. The nipple she rested does look a little better
(forming a scab), but doesn't feel better. During the night
she breastfed on both breasts.
I watched her latch during group, and it looked good to
me. Didn't have a glove, but the mother said I checked his
palate before. Tongue seemed OK. He weighs 9 lb., possibly
a little underweight for 7 weeks. About 12 voids in 24
hours, and I am quite sure that she is giving nothing but
breast milk. She says that for the last week or a little
more, he never comes off by himself. She plans to come in
on Tuesday. I suggested shorter, more frequent hand
expression, warm packs before expressing, and continue
resting one nipple to see if we can heal one at a time. I
also told her to use the APNO after EVERY feeding. I don't
like the fact that she has already been using it for 6
weeks. Her nipple (think I actually only saw one) looked
very clean, but completely raw--no skin at all on the tip.
She is air drying for a little bit before putting on the
ointment. One suggestion I gave (and not too sure if it was
a good idea) since she said he takes 2 oz. in 5 minutes, was
to give one ounce, trying to hold him and give him a
pacifier for a few minutes, then give the second ounce of
EBM. I made this suggestion before she told me that he was
not ever coming off the breast spontaneously.
One thought that has gone through my mind with frequent
voids and marginal weight gain is diabetes insipidus (sp?)
Does anyone have an idea. She really does not want to give
formula. Is there a pump that would be better than hand
expression? I don't remember baby's birth weight. I'm
think it was around 6 lb. Mom is small build. To the best
of my recollection, baby was term or very nearly term. (I
received this call at home, and the records are at the
hospital.) We haven't discussed galactagogues. She was
using hydrogel at first--don't know if she was mixing
hydrogel and APNO. I will plan to refer her to her own
physician and to her pediatrician if things aren't looking
better by Tuesday.
Please reply privately as well as to the list as I am
NOMAIL. Thanks for any and all suggestions.
Bonnie Jones, RN, IBCLC
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