How do your babies with broken clavicles generally present?

I had one yesterday that would not wake up.  My feeling is that perhaps she
had "shut down" due to the pain, but as the first day passed and the second
day began and she did not begin to become more alert, my willingness to
wait evaporated.  If I could have kept the mom (young, primip) and baby in
the hospital until we got bf going, I would have felt much more
comfortable.  Another LC had gotten the mom to pump the first morning, but
24 hours later when I saw the pt on rounds, she had not pumped again.
(Clearly the first LC needed to get the pt's nurses involved in keeping the
pt on her pumping schedule,  rather than leaving it up to the
pt.--hindsight).

I saw her just prior to discharge.  I worked with the baby for over an
hour,  no attempt to bf at all.  Finally got a little rooting toward the
hand and  felt encouraged.  Had the mom pump and finger feed--5 cc.  Sent
the mom to WIC to pick up a pump (by prior arrangement) and strict
instructions to pump and finger feed every two hours that mom was awake
(but not to wake herself if sleeping).   The father said he was completely
opposed to formula, and would give the baby water if she wouldn't wake up
to bf.  I told him that he was right in assuming that babies were meant to
get breastmilk, but if a baby didn't get breastmilk for whatever reason,
then I would prefer formula, which although inferior to breastmilk, was
closer to breastmilk than water, and that water could cause more problems.
I also agreed that it was time for this baby to eat, and for that reason it
was important for the mom to pump and finger feed from now until the baby
woke up to nurse.  I taught the dad to fingerfeed and he seemed to really
get into it.

I called them at home that night, father said he was worried, baby hadn't
woken up yet (36 hr pp); mother when questioned said she was not getting
much when pumping (5 cc) and wasn't pumping as often as I had suggested.  I
would have been willing to go through the night pumping and finger feeding
even small amounts, except that I didn't like the sound of  things and felt
the compliance was marginal.  So I advised the mom to continue pumping and
finger feeding, but to also supplement by fingerfeeding with Nutramigen,
and to come back in the morning for a breastfeeding assessment.  I assured
her we would preserve the breastfeeding relationship.

The delivery was unmedicated.  No other notations on pts chart other than
to "watch" the "possible birthmark" on baby's forehead, which looks like a
stork bite.  Father had refused acetominophen for baby--do you think this
would have helped baby become more wakeful?

I felt bad suggesting introducing formula to this baby (how often do I get
a mom who is committed to exclusive breastfeeding?  Hardly ever!).  But I
was trying to see into the future--how long was this baby going to stay
sleepy?  When was this mom going to start really getting pumping going?
Was there anything else going on with the baby? Was jaundice going to
become part of the picture?  A baby who is nursing is generally getting
more colostrum than a primiparous mother pumps, and from the amounts pumped
it was clear she wasn't up to normal colostral intake.

Any other experiences with broken clavicle similar to this?

Arly Helm in Utah

[log in to unmask] (Arly Helm, LC)