Re: Help for a mother

[Guest guest]

Hello, Nanci.

Well, there are several issues here. I will try to work my way through them.

First thing I noticed is that you state you have permission to post, but you talked with the aunt of the babies, not their mother. Did you get the *mother's* permission to post? We actually need that, rather than the permission of the person we are talking with if not the mother.

OK, that said, I would be suggesting to the aunt that, if at all possible, you really should be talking directly with the mother. Things sometimes get twisted in re-telling, both from mother to you via aunt, and from you to mother via aunt. Not suggesting aunt is incapable of relaying a message, just that it's human to misinterpret things. Remember the "telephone game" from when we were kids? And the mother is more likely to know all the answers to your questions, whereas if often happens that you will ask a question that the family member (aunt, grandma, whoever called you) doesn't know the answer to, so you have to wait for phone tag to occur back and forth before you can tailor your suggestions specifically based on the answer to the question.

Now, should the mother use a bottle? Well, you need to give her (preferably the mother, not the aunt) information about the options and let her decide for herself. Some mothers are very adamant about not wanting to use one and if someone insists, they stop listening. On the other hand, a finger is much firmer in the baby's mouth than a mother's nipple. So a baby can get used to that firmness and have trouble making the switch to mom's nipple as mother builds her supply. So you can also suggest that a bottle, done appropriately--which you will describe--can offer a transition between a finger and a mom's nipple. The bottle nipple is softer than the finger, yet firmer than the mom's nipple. The bottle nipple can also be inserted to help the baby open wider, like baby needs to do at breast, whereas baby keeps a tight mouth around a finger and there's no way to open wider because then there

will be a gap and no seal, so no suction.

If the babies truly both have a poor suck, then yes, the mother needs to be pumping. But before suggesting any galactogogue, you have to make sure of a number of things:

What type of pump is she using?

Has she been fitted for proper flange size? Or did someone just hand her something at the hospital and say, "Here, try this."? Since the mom probably doesn't know what it's supposed to look or feel like, she may not know that she might possibly still have an incorrect size. And very few mothers ever consider that they may actually need to use two different sized flanges. They never think that their ears and feet aren't the same size, so their nipples are probably also different, which may or may not require the use of different sizes on the two nipples. If babies are not coming to breast, she should be pumping 20 minutes for multiples, at least until supply is well-established. And is she pumping through the night?

Galactogogues can't work if the breasts are not being drained well, and it doesn't sound right now like you actually know if the breasts are being drained well. Personally, I like to make sure everything about pumping is in proper order before suggesting to spend more money on galactogogues. If any change is made (changing type of pump, or changing flange size, for example), I suggest that mother may want to wait 4 days to see what the change can accomplish before spending money on more stuff.

I'm sure others will chime in with the stuff I'm not thinking of right now, but this list can at least get you started with what you need to be considering.

Dee Kassing

Permissiom to post. I got a call from a friend yesterday whose sister had twins last week. They were 36 weeks gestation. She is breastfeeding, and finger-finger with a syringe beause she said they have a poor suck. She's pumping every 3 hours and not getting much.

She apparently called a LLL hotline and talked to her nurse, they both told her to give a bottle to help them suck.

Since I'm new to this profession, I'm asking for help. Should she give a bottle, should she take something to increase her milk supply?

Thanks a bunch!

Nanci

[Guest guest]

THANK you very much Dee, I'm waiting for a call from the mother.....I'll have more information then. She doesn't live by me, so that makes it difficult too.

Nanci

To: Sent: Wednesday, December 28, 2011 3:04 PMSubject: Re: Help for a mother

Hello, Nanci.

Well, there are several issues here. I will try to work my way through them.

First thing I noticed is that you state you have permission to post, but you talked with the aunt of the babies, not their mother. Did you get the *mother's* permission to post? We actually need that, rather than the permission of the person we are talking with if not the mother.

OK, that said, I would be suggesting to the aunt that, if at all possible, you really should be talking directly with the mother. Things sometimes get twisted in re-telling, both from mother to you via aunt, and from you to mother via aunt. Not suggesting aunt is incapable of relaying a message, just that it's human to misinterpret things. Remember the "telephone game" from when we were kids? And the mother is more likely to know all the answers to your questions, whereas if often happens that you will ask a question that the family member (aunt, grandma, whoever called you) doesn't know the answer to, so you have to wait for phone tag to occur back and forth before you can tailor your suggestions specifically based on the answer to the question.

Now, should the mother use a bottle? Well, you need to give her (preferably the mother, not the aunt) information about the options and let her decide for herself. Some mothers are very adamant about not wanting to use one and if someone insists, they stop listening. On the other hand, a finger is much firmer in the baby's mouth than a mother's nipple. So a baby can get used to that firmness and have trouble making the switch to mom's nipple as mother builds her supply. So you can also suggest that a bottle, done appropriately--which you will describe--can offer a transition between a finger and a mom's nipple. The bottle nipple is softer than the finger, yet firmer than the mom's nipple. The bottle nipple can also be inserted to help the baby open wider, like baby needs to do at breast, whereas baby keeps a tight mouth around a finger and there's no way to open wider because then there

will be a gap and no seal, so no suction.

If the babies truly both have a poor suck, then yes, the mother needs to be pumping. But before suggesting any galactogogue, you have to make sure of a number of things:

What type of pump is she using?

Has she been fitted for proper flange size? Or did someone just hand her something at the hospital and say, "Here, try this."? Since the mom probably doesn't know what it's supposed to look or feel like, she may not know that she might possibly still have an incorrect size. And very few mothers ever consider that they may actually need to use two different sized flanges. They never think that their ears and feet aren't the same size, so their nipples are probably also different, which may or may not require the use of different sizes on the two nipples. If babies are not coming to breast, she should be pumping 20 minutes for multiples, at least until supply is well-established. And is she pumping through the night?

Galactogogues can't work if the breasts are not being drained well, and it doesn't sound right now like you actually know if the breasts are being drained well. Personally, I like to make sure everything about pumping is in proper order before suggesting to spend more money on galactogogues. If any change is made (changing type of pump, or changing flange size, for example), I suggest that mother may want to wait 4 days to see what the change can accomplish before spending money on more stuff.

I'm sure others will chime in with the stuff I'm not thinking of right now, but this list can at least get you started with what you need to be considering.

Dee Kassing

Permissiom to post. I got a call from a friend yesterday whose sister had twins last week. They were 36 weeks gestation. She is breastfeeding, and finger-finger with a syringe beause she said they have a poor suck. She's pumping every 3 hours and not getting much.

She apparently called a LLL hotline and talked to her nurse, they both told her to give a bottle to help them suck.

Since I'm new to this profession, I'm asking for help. Should she give a bottle, should she take something to increase her milk supply?

Thanks a bunch!

Nanci

[Guest guest]

Hello, again, Nanci.

Sometimes, if the feeding really should be observed and the mother isn't near, you can either suggest a Skype consult if you have the technology and know how to use it, or you can find out where she lives and ask here on this group if anyone lives near the mother so you can refer her to someone closer. Of course, you could always just refer her to the Find an LC button at ilca.org, *but* I personally trust those of us on this group more than a name off a list, because I figure all the IBCLCs on this list are here because they want as much knowledge as possible to be the best IBCLC they can be.

Dee KassingPermissiom to post. I got a call from a friend yesterday whose sister had twins last week. They were 36 weeks gestation. She is breastfeeding, and finger-finger with a syringe beause she said they have a poor suck. She's pumping every 3 hours and not getting much.

She apparently called a LLL hotline and talked to her nurse, they both told her to give a bottle to help them suck.

Since I'm new to this profession, I'm asking for help. Should she give a bottle, should she take something to increase her milk supply?

Thanks a bunch!

Nanci

[Guest guest]

Yes, she needs help with her milk supply and IMO finger feeding is a very difficult and time-consuming way to feed a baby. And they can start sucking like they're using a straw. And of course the babies need to be evaluated to determine why they have "poor sucks."good luck! Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comwww.facebook.com/thesecond9months.--- On Wed, 12/28/11, Nanci Klein

wrote:Subject: Help for a motherTo: " " < >, "IBCLC2B " <IBCLC2B >Date: Wednesday, December 28, 2011, 10:05 AM

Permissiom to post. I got a call from a friend yesterday whose sister had twins last week. They were 36 weeks gestation. She is breastfeeding, and finger-finger with a syringe beause she said they have a poor suck. She's pumping every 3 hours and not getting much.

She apparently called a LLL hotline and talked to her nurse, they both told her to give a bottle to help them suck.

Since I'm new to this profession, I'm asking for help. Should she give a bottle, should she take something to increase her milk supply?

Thanks a bunch!

Nanci