Karyn-grace,
I did not see any answers to your post on 3/5/07. I hope you can tell where
my thoughts are and where snippets from your post are << >>. Here are my
thoughts, hope they are of some use 4 days later. This baby was born in
November and it seemed the breastfeeding did not get off to a very good
start. <<(mom and baby separated for 4 hours post birth~baby not put to
breast until 4 hours>>. You say mother's milk came in on day 3, I would want
to know the details of this. I have posted recently that mothers with low
supply often report by phone that their milk came in, but they have no frame
of reference for this and I've found virtually all of them had a very slight
fullness and not the usual "wham!" increase in supply. The following are the
many red flags from your post, and I beleive this is a seriously low supply
situation that may have originated as maternal factors or baby feeding
ineffectively from birth or both: <<paci used regularly from
birth...possibility of missed feeding cues, a bottle of formula was
introduced at bedtime, as it seemed to "calm baby and help her sleep," mom's
main concern was baby's fussiness and refusal of breast, which was getting
worse and worse each day, so much so that mom was 'resorting' to bottle of
formula after attempting nursings, appeared frustrated with the whole bf
process, baby is very oral, with her hands to her mouth all the time>>
All the above are signs the baby was hungry.
<<~baby has small 'skin tag' on side of tongue - looks like an enlarged
gland - not susepcted to interfere with bf/ding>> This would worry me a
bit, I think this needs further evaluation. It may certainly be affecting
feeding. And more red flags from your post follow, indicating a
possibly underfeeding infant and a definite low supply to me.
<<~from 4 weeks, sleeps 7 or 8 hours per night after the bottle of formula
(thereby mom not having her breasts stimulated for 10 or more hours) ~mom
has very minimal success with pumping or hand expression ~mom does not feel
let downs>>
Now I wonder about this statement: <<mom had seen countless hcp's about
bf/ding before contacting me>> I wonder if she keeps getting appropriate
info but is just not following it, for whatever reason. I am willing to bet
others had recommended a consult, a baby weight, more frequent feeding,
discontinue pacifier, a pump rental, etc. I do not think the
domperidone/herbs will help unless the mother begins a serious relactation
process with direct bf/nursing supplementer or hospital grade pumping 10x a
day. I also do not think mom should be eliminating the formula unless
mom/baby are followed much more closely (needs to be in person for this one,
I think). Adding 1 or 2 (not always 2) ineffective feeds will not make up
for a big bottle of formula in volume. Apparently baby is still frustrated:
<<mom started domperidone two weeks ago...took it for 3 or 4 days~mom
dropped the bottle of formula and added one or two nursing sessions in 24
hours ~mom refined her latch, positioning, and began using breast
compression baby stays on longer, but still get frustrated when milk is not
immediate>>
<<Feb 13 10lb 9oz / Feb. 27 = 10lb 5 oz / same scale>> Do we have another
weight?
<<~baby gets no formula, and now wakes 1x per night for feeding ~baby still
uses paci, but less often than before~typical day is wake/feed at 6am; cat
nap at 7:45am using paci; =
wake/feed at 8:15am; cat nap @ 10:00am using paci; wake/feed at 10:30am; cat
nap at 12:30pm using paci; wake/feed at 2:00pm.~baby does not nurse to
sleep>> There are too many missed opportunities to nurse, and the pacifier
should be discontinued in my opinion.
Laurie Wheeler, RN, MN, IBCLC
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