As we get more and more insight (many published articles) about the
conditions that delay lactogenesis or contribute to high risk lactation and
risk factors for early weaning, it seems to me that these moms could be
targeted for specific intervention in the form of anticipatory guidance. If
the mom has PIH, anemia, c-section, and baby is slightly early, for example,
the mom would be given a handout that says something like:
" Sometimes a mother's milk comes in a few days later than normal. This can
happen when: (INSERT CHECK LIST OF KNOWN RISK FACTORS AND CHECK OFF THE MOMS
SPECIFICS or PUT IN A BLANK LINE AND WRITE IN HER SPECIFIC RISK FACTORS)
If that happens, the baby may lose a bit more weight than usual, and will
become sleepy at breast. The baby then may not be able to stimulate the
breasts enough to bring in the milk. To make enough milk a woman's breasts
must be well stimulated during Weeks 1,2 and 3.
To bring in your milk, we'd like you to get a rental grade pump for
__week(s), and pump ________ times each day.
Feed the baby formula if the baby loses ________ oz of weight or doesn't
have 3-4 yellow poops a day by Day 3-4.
Supplementation on Day 2 ________
Supplementation on Day 3_________
Supplementation on Day 4_________
Supplementation on Day 5_________
(write in physiologic volumes for those days)
A short delay in the milk coming in is a TEMPORARY problem. You will still
be able to breastfeed. KEEP PRACTICING BREASTFEEDING AT EVERY FEEDING.
This way the baby won't forget what to do once pumping brings in your milk.
Please visit your pediatrician, midwife or clinic on Day 5 for a weight
check. You will get help to decide what to do next at that visit."
Such a handout could be printed on colored paper and even in a busy
institution could be personalized in a few minutes. You could print out the
ph numbers of local pump depots, numbers of out patient LCs, LLL, WIC, etc.
You could leave a blank space to write in stuff about fenugreek, diet (if
mom needs more protein to help reduce edema, etc). Any prescriptions for
galactagogues could be stapled to the form.
Then parents wouldn't have to blame themselves, or be frightened or
confused, and would have a plan if there is a delay. Accompanied by a poop
and pee chart, such a handout would be a real safety net. Please feel free
to revise or copy the above ideas with my permission; this is just a quick
mock-up and I haven't checked the reading level. Occasionally I do see
people who have taken photos or our log form from the Diapers of the
Breastfed Baby (our Diaper Diary, "Poop Sheet") and modified them for their
own use. Those materials are protected by copyright and may not be
duplicated.
Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com
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