I am looking for tips in how to deal with a very common problem where I
work.  I will illustrate it with a case from last week - some variation of
this is the norm!

First time mother, came in at night in early labour.  Given Dormonoct
(loprazolam) to sleep.  Later, as labour progressed given Pethidine
(meperidine) and Aterax (hydroxyzine) intramuscularly. Taken to theatre a
few hours later (not sure of time - charts at hospital) for Caesarean
(spinal - fentanyl).  Reason for CS - fetal distress.  Baby born with Apgars
of 9 and 10, weight 3400g.

Mother returned to postnatal ward with PCA Morphine after 30 minutes in
recovery.   Very tired and overwhelmed and experiencing nicotine withdrawal.

Baby taken to her naked.  Baby screamed almost non-stop for 6 hours.
Continuous skin-to-skin contact for 2 to 3 hours.  Tried to facilitate self
attachment.   Some rooting, but baby was too distressed to get his act
together.

30 mls colostrum expressed and given to baby via teaspoon - no change in
behaviour.  Did this again a little later and baby eventually fell asleep
exhausted.  Next day was a little better - baby went home on day 4 fully
breastfed and calmer.

A bonus in this case was the abundance of colostrum from the beginning.
Usually this is not the case and babies are supplemented - which undermines
the mother further - and usually ends with her abandoning breastfeeding.

It is so frustrating to deal with abnormal situations on a daily basis.  I
always marvel at the babies that do go to the breast easily after a less
than ideal start - fortunately we do have some of those!  It appears that
the more the baby cries, the more the mother feels inadequate and the more
likely that she will stop breastfeeding.

Jean Ridler  RN  RM  IBCLC
South Africa   [log in to unmask]

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