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Subject:
From:
PHYLLIS M KOMBOL <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sat, 9 Nov 1996 07:52:05 -0500
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-- [ From: Phyllis Kombol * EMC.Ver #2.5.1 ] --

Hi again!  I'm a LC at a big hospital; have been able to read only
sporadically but ran into a case yesterday that I wondered if anyone
else has had experience or suggestions to share.  I'm sure all on the
list will be interested, but would you also email to my private address
since it may be awhile till I get through the digests  and would like to
offer suggestions on follow-up with this family monday.

Mom with "Schmidt's" disease/disorder/syndrome with newborn baby born
Thursday evening.  She wants to try breastfeeding. All are concerned
about milk production capability because from what this mom told me
about her disorder (I couldn't find in my references) this is a chronic
autoimmune disorder that attacks glands whenever physiologically
stressed (eg. illnesses such as flu).  Has no thyroid gland; takes
thyroid replacement.  Has never had periods; was told no ovarian
function or follicles so would never have children.  Was surprised (as
were her docs) when found to be pregnant.  Presented with unexplained
weight loss of 20 lbs. and for workup for possible uterine cancer
because of lack of cyclic hormonal function.  Found to be 18-20 weeks
pregnant; had thyroid replacement increased and was able to maintain the
pregnancy normally, labor and delivery quite normal, but states no
noticeable breast changes during the pregnancy.

Baby initially was spitty, did not nurse in labor and delivery (not sure
if offered), had chemstrip (glucose) 35 so was offered glucose water in
nursery, spit and sputtered so much nurses were cuncerned re patency of
esophagus but were able to slip an orogastric tube in without trouble.
Finally got one ounce out of the bottle though the nurse who fed said he
wore more than he ate.  Chemstrip did come up to 40.  I worked with mom
and baby at about 12-14 hrs after birth since he had never nursed.  Baby
arouseable but not at all interested in feeding; showed mom positioning,
ways to hold breast, entice, etc. Left baby skin-to-skin with her.  Left
her with written feeding plan: keep baby in room, lots of skin to skin
contact with mom/dad, wake and offer breast at least every 2 hours and
anytime he gives feeding cues, supplement with expressed milk/formula
(bottle) after every other time offering breast if not nursing (so he
gets something to eat at least every 4 hours), pump each breast 10-15
min. each time he gets supplement.  Reviewed guidelines for expected
progression of baby's feeding skills/volume of intake and output.
Encouraged her to get hospital grade pump for home use and see what
happens as the days go by.  If no evidence of milk production (breast
changes/baby wets and poops eating at breast with less than full volume
supplements) by 1 week postpartum we may have to conclude no milk.

OK y'all--give me your best guesses:  Does she have prolactin?  Will she
make milk?  enough?  Have we ever seen this before?  What else should I
be thinking about?  Anything I should tell the peds office staff who
will be following her breastfeeding course with her baby? (They have an
IBCLC on staff, to whom I sent a copy of my notes and feeding plan.)

I'm not sure how motivated/supported she will be, as I left my beeper #
to call for another feeding later in the day and never heard back or got
back to recheck.  We're a pretty bottle-feeding-friendly hospital and
yesterday was a relatively "quiet" day as I only had 38 babies on my
consult list....thank god over half of them NOT listed by their nurse as
"have to be seen by the LC today" (but I was also teaching a nurse who
was rounding with me so she can better decide if/when her patients do
"have to be seen by LC").

A BIG TIA!

P.S.  Even if you don't know anything about Schmidt's, sympathy re my
unmanagemable job |:,-(  or instructions on how to clone myself  8-) and
offers to come help me ;-)  are also appreciated!  There's one more
position currently open and another to be created in January, but I'm
the only one for now. EGAD!

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