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Subject:
From:
Barbara Wilson-Clay <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Fri, 31 Mar 2000 08:24:47 -0600
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RE:  the mom with twins and PCOS.  In the 7 days prior to my visit the mom
had been nursing very frequently, but who knows how effectively.  She had
been nursing simultaneously, which can be problematical in terms of getting
either twin well latched when mom is an inexperienced primip.  If I see
twins who arent robust and aren't nursing well, I often suggest sequential
feeding so more attention can be paid to a really good latch and to free up
one hand for breast compression.  This was demonstrated on Day 7 and I
reviewed the sounds and appearances of nutritive sucking vs non-nutritive.
Breast compression proved ineffective on day 7.  There were very few
swallows even when babies were well latched, and, as I mentioned, intakes
were very low by test weight (which was used as a way to confirm the
clinical impression of scant intake.  By the way, mom was not told we would
use the scale for test weighing.  She thought it was just there to get a
weight check).

 Given the fact she did exper. some engorgement (a good sign) on Day 4, this
mom may well fall into the category of women  whose med. history demands
that there be on-the-money management of lactation, because any deficits in
milk removal at the moment of lactogenesis II (i.e. prolonged engorgement)
may trigger rapid involution due to their hormonal imbalances.  I wish that
on Day 4 we could have started stim. with a good pump and working with good
latch.  Little twins sometimes don't suck really well right away, and this
type mom maybe should always be watched and managed closely to maximize
every chance they have to bring in some milk.  I see this as a case where
some earlier intervention might have had a slightly better shot at helping
her.  By Day 7 she was completely flaccid, and as I pointed out, nothing we
did further improved that.  Did I use a feeding tube device so babies could
be fed formula at breast.  No.  I told her about it.  It seemed like more
work than she could cope with given her circumstances.

Also, during intake on Day 7, when I heard her medical hx, I didn't make any
comment about it to her.  I communicated to her very hopefully that I
thought our interventions could assist her.  I didn't want to set up an
emotional block for her milk coming back if fatigue or stress had
temporarily depressed her supply.  On Day 10, the Reglan was presented as a
way to "jump start" her.  It wasn't until that and the pumping, and
skin-to-skin, rest, etc. failed that I reviewed my suspicions about a
hormonal reason for her production problems.  That's when she shared about
the MRI and the prolactin levels being "off" on top of the PCOS and
fertility problems.

Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates, Austin, Texas
http://www.lactnews.com

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