Dear Mary, You have one other option - stop seeing her- You have given her lots of help and options , she is an adult. She needs to own the breastfeeding, not you. I sense you are caught up in her anxiety and she is not compliant. Good luck with your private practice - Karen Querna, RN, BSN, IBCLC Spokane, WA > > Date: Mon, 15 Dec 2003 09:10:40 -0500 > From: Mary Jozwiak IBCLC <[log in to unmask]> > Subject: Almost out of options, sheild AND SNS together? > > I have permission from the mother to post. > > Long story. Saw baby at 3 weeks, mom says "not enough milk." Observed baby, > found moderately tight frenulum. Mother VERY distracted by 2 yr old. Kept > getting up, to tend to her (she was *fine*) during breastfeeding baby.Baby > poppin off every time. Baby latched "OK" Mom had slightly delayed MER, but > baby gained 3.5 oz (Medela elect scale) in about a 20 min, both side > nursing, using the first breast twice. Mom was using about 6 oz ABM sup a > day at this point. I showed her Compression, better latch, leaving the baby > on until several MERs occured, and tongue exercizes. Gave referal to MD I > use who frequently performs frenotomies, told mother it was essensial he > evaluated. Left her with a pump, instructed to pump every 2-3 hours, after > each nursing. Showed cup feeding for sups, left instructions for reducing > sups as milk catches up. (Baby does NOT like the ABM!) Baby had gained 10 > oz a week since lowest discharge weight. Told mom I had to weigh him in 3-5 > days. > > One week later. Mom didn't call or set up weighing appt. I couldn't reach > her. Was temp living in family member's home while home was being painted. > Asked if she had seen MD for tongue. Nope. Asked if pumping. "It's hard, > someone will hear me." (?)Claims pumping "about 4 times a day" In the > *bathroom* at her brother's home! Asked if using tongue exercises to help > stretch. Nope. Toddler makes it "too hard." Baby now up to about 10 oz ABM > a day. Told her I NEEDED to weigh baby. Told her she NEEDED to see MD. > > Send report to MD. Mom said it was "too far" to come to me for weighing. > (It really is moms' responsibility to come to me for a weight check. I > don't charge for them. I thought a follow up consult would be useless until > MD was seen.) Told her we would recommence after MD visit, but I really > needed to weigh this baby. Tole me she would have MD weigh. Two days later, > She finally Saw MD, he said "It isn't bad enough to snip." > (ARGHGHGHGHGGHGH!) MD did not weigh baby, although I really stressed that > she should ask him to. She "forgot." > > Mom is not keeping adequate records, says she "thinks" baby is having 5-6 > wet and one big poop a day, (he's 5 weeks now) says pumping 4-5 times a > day, 20 min, getting only 1 oz. Refused to try galatagouges. Tried to > schedule an other consult. Said she would "Try" to pump more and "wait." I > said, "Don't 'try' DO it!" Asked her to please come in for weigh. She > didn't.(Again the fact that she has a 2 year old is used to excuse lack of > compliance.) > > Yesterday, called in a near panic. Yet not much has changed. Still not > pumping enough. Thinks she is "losing my milk." "baby is needing more > formula." Yet still using the *same amount* of ABM he was over a week ago. > When I pointed out that *I* was keeping records, and that she is using the > same amount of ABM as a week ago, she said "Oh." Expalained a baby at her > baby's weight is taking about 30 oz a milk a day, if 10 oz of ABM, SHE is > still providing 20 oz or more. Stressed importance of record keeping. Made > appointment (finally!) for today. > > She is going to need a supplementer. I can't count on her to pump. BUT she > is STILL nursing. (Amazing!) This is the only ray of light in this > situation, the fact that this baby LOVES to nurse. She will *not* tolerate > and other referal to an other ENT or ped dentist for this tongue. The > tongue IS working, yet he could be doing a bit better. I also feel he might > get a better latch (mom says he tries to nippple feed, I stressed she > needed to take him off and relatch when he does this.)with a sheild, but > with her lack of record keeping and precarious supply, I am not really > comfortable with shield alone. I KNOW she would use the sheild! But may not > pump to continue supply. I won't know the story thus far until I see him > nurse and finally weigh him this afternoon. > > My hairbrained scheme. Try a shield to see if he latches more deeply. > THEN, Thread an SNS tube THROUGH the hole in the sheild and have her use it > (this contraption) at ever OTHER feeding, and then really stress she HAS to > pump after she does this. Do every other feeding on the bare breast. > > This would give him a deeper latch, AND sup him at the same time, > eliminating her bottle usage. I feel with his tongue,and her slow to start > MER he is going to become more dependent on the bottle and ABM if something > more drastic isn't done. > > I will watch a feeding and then introduce this thing (Sheild/SNS) I made > this morning. (At about 5:00 AM, because I couldn't sleep thinking about > it.) > > I HATE to gadgetize this baby, but he *does* need the supp, at least for > the time being, and a deeper latch will only benefit both of them. (Mom has > told me "how much faster" the bottle feedings go....) But mom does NOT want > to quit. > > Input please. I am only doing this, as this mother cannot be counted on to > keep adequate records, seems to panic easily (and then give more ABM) and > seems to have a hard time with compliance. I think she may actually USE > this device, the baby will get more milk, a better latch, and she will be > more stimulated. Her problems with compliance may actually work in their > favor, as she probably won't want to be bothered using this thing at EVERY > feeding, which would be perfect! > > Why do I feel I have to justify this plan of attack? > > Input please, Wise Ones. > > Mary Jozwiak IBCLC, RLC, LLLL, AAPL > Private Practice > > *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html