First consultation

[Guest guest]

I had my first ever paid for consultation as an IBCLC. Oh the many

doubts that were going through my mind as I was driving to and from

this mother's home. How I would have like to be accompanied by a

very experienced LC.

Had to see this mom for a slow weight gain of a 2 week old baby.

Lost over 200 grams in first 7 days and is gaining only 10 grams per

day. Close f/up with baby's pediatrician is ongoing. Mother

supplementing with EBM. History of milk and egg allergy with

previous sibling so mother does not want to use formula at all or

unless absolutely necessary and it will have to be a non-allergenic

formula (very expensive)such as Nutramugen. This issue will be

addressed between mother and baby's pediatrician if needed.

Mother had no breast size change during pregnancy and experiences

minor size change once lactation has begun (goes from 36B to 36B+ or

slightly fuller B-cup).

I recommended frequent extraction with electric breastpump,

supplementing after every feed, modifying position and latch and

breast compression during entire feed to increase flow and quantity

of BM baby is getting.

Mom will see Pediatrician on Monday and I'll be in touch with her

afterwards. I'm hoping that we will see a better weight gain after

4 days of supplementation and breast compressions. Baby is small (6

lb or 2725 g at birth) and is not sucking very efficiently. I'm

hoping that this baby will become stronger and start sucking more

efficiently as she will hopefully be getting more milk.

First baby (boy) was nursed for 30 months but was supplemented from

day 1 because of hospital policy regarding supplementation after a C-

section. He ended up with nipple confusion that entirely resolved

itself only after 4 months. Supply was always an issue so Mom

supplemented all the time. First baby was always low in the growth

chart (10 % or 25 % for weight, and 50 % for height).

I'll keep you posted on the progress of this dyad.

Ghislaine Reid

[Guest guest]

Thanks for sharing this Ghislaine. Still waiting for my first one -

next year hopefully!!

This sounds like a consult(unpaid voluntary whilst waiting for

results) I did in September. Have you thought about 10 days of

domperidone whilst pumping every couple of hours?

BTW. does anyone know off hand what the 'dom' dosage would be - i've

just discovered that it is sold 'over the counter' here, but am not

sure that it is the same as a 'prescribed' dose.

Was this baby born by cs by any chance? - just curious really - I

feel this is becoming more common and according to Michel Odent a cs

can suppress the natural oxytocin initially (something that I feel I

shall be looking into shortly)

Thanks

Pam

p.s. did you receive the' expressing and storing' thing Ghislaine

> I had my first ever paid for consultation as an IBCLC. Oh the many

> doubts that were going through my mind as I was driving to and from

> this mother's home. How I would have like to be accompanied by a

> very experienced LC.

>

> Had to see this mom for a slow weight gain of a 2 week old baby.

> Lost over 200 grams in first 7 days and is gaining only 10 grams

per

> day. Close f/up with baby's pediatrician is ongoing. Mother

> supplementing with EBM. History of milk and egg allergy with

> previous sibling so mother does not want to use formula at all or

> unless absolutely necessary and it will have to be a non-allergenic

> formula (very expensive)such as Nutramugen. This issue will be

> addressed between mother and baby's pediatrician if needed.

>

> Mother had no breast size change during pregnancy and experiences

> minor size change once lactation has begun (goes from 36B to 36B+

or

> slightly fuller B-cup).

>

> I recommended frequent extraction with electric breastpump,

> supplementing after every feed, modifying position and latch and

> breast compression during entire feed to increase flow and quantity

> of BM baby is getting.

>

> Mom will see Pediatrician on Monday and I'll be in touch with her

> afterwards. I'm hoping that we will see a better weight gain after

> 4 days of supplementation and breast compressions. Baby is small

(6

> lb or 2725 g at birth) and is not sucking very efficiently. I'm

> hoping that this baby will become stronger and start sucking more

> efficiently as she will hopefully be getting more milk.

>

> First baby (boy) was nursed for 30 months but was supplemented from

> day 1 because of hospital policy regarding supplementation after a

C-

> section. He ended up with nipple confusion that entirely resolved

> itself only after 4 months. Supply was always an issue so Mom

> supplemented all the time. First baby was always low in the growth

> chart (10 % or 25 % for weight, and 50 % for height).

>

> I'll keep you posted on the progress of this dyad.

>

> Ghislaine Reid

[Guest guest]

Hello Pam,

Yes, I have tought of Domperidone. However, I first want to see how the baby is doing with supplements and how the milk production will increase with regular pumping. Some LC here also work with Fenugreek and Blessed thistle and seem to have great success.

What is cs ?

For the dosage of Domperidone, here is what Dr. Jack Newman recommands :

Using Domperidone:

Generally, we start domperidone at 20 milligrammes (two 10 mg tablets) four times a day. If taking domperidone 4 times a day is inconvenient, 30 milligrammes (three 10 mg tablets) three times a day is fine. Printouts from the pharmacy often suggest taking domperidone 30 minutes before eating, but that is because of its use for digestive intolerance. You can take the domperidone about every 6 hours, when it is convenient (there is no need to wake up to keep to a 6 hour schedule—it does not make any difference). Most mothers take the domperidone for 3 to 8 weeks. Mothers who are nursing adopted babies may have to take the drug much longer.

After starting domperidone, it may take three or four days before you notice any effect, though sometimes mothers notice an effect within 24 hours. It appears to take two to three weeks to get a maximum effect.Reference : http://users.erols.com/cindyrn/20.htm.

Ghislaine Reid

Re: First consultation

Thanks for sharing this Ghislaine. Still waiting for my first one - next year hopefully!!This sounds like a consult(unpaid voluntary whilst waiting for results) I did in September. Have you thought about 10 days of domperidone whilst pumping every couple of hours? BTW. does anyone know off hand what the 'dom' dosage would be - i've just discovered that it is sold 'over the counter' here, but am not sure that it is the same as a 'prescribed' dose.Was this baby born by cs by any chance? - just curious really - I feel this is becoming more common and according to Michel Odent a cs can suppress the natural oxytocin initially (something that I feel I shall be looking into shortly)ThanksPamp.s. did you receive the' expressing and storing' thing Ghislaine> I had my first ever paid for consultation as an IBCLC. Oh the many > doubts that were going through my mind as I was driving to and from > this mother's home. How I would have like to be accompanied by a > very experienced LC.> > Had to see this mom for a slow weight gain of a 2 week old baby. > Lost over 200 grams in first 7 days and is gaining only 10 grams per > day. Close f/up with baby's pediatrician is ongoing. Mother > supplementing with EBM. History of milk and egg allergy with > previous sibling so mother does not want to use formula at all or > unless absolutely necessary and it will have to be a non-allergenic > formula (very expensive)such as Nutramugen. This issue will be > addressed between mother and baby's pediatrician if needed.> > Mother had no breast size change during pregnancy and experiences > minor size change once lactation has begun (goes from 36B to 36B+ or > slightly fuller B-cup).> > I recommended frequent extraction with electric breastpump, > supplementing after every feed, modifying position and latch and > breast compression during entire feed to increase flow and quantity > of BM baby is getting.> > Mom will see Pediatrician on Monday and I'll be in touch with her > afterwards. I'm hoping that we will see a better weight gain after > 4 days of supplementation and breast compressions. Baby is small (6 > lb or 2725 g at birth) and is not sucking very efficiently. I'm > hoping that this baby will become stronger and start sucking more > efficiently as she will hopefully be getting more milk.> > First baby (boy) was nursed for 30 months but was supplemented from > day 1 because of hospital policy regarding supplementation after a C-> section. He ended up with nipple confusion that entirely resolved > itself only after 4 months. Supply was always an issue so Mom > supplemented all the time. First baby was always low in the growth > chart (10 % or 25 % for weight, and 50 % for height).> > I'll keep you posted on the progress of this dyad.> > Ghislaine Reid

[Guest guest]

Always a good idea to start with first things first - I jst

mentioned 'dom' 'cos I didn't know how popular it was there. I will

check the Jack Newman dosage with the 'over the counter' version

here - thanks (i've only ever montioned 'dom' twice and know of one

that used it!)

-cs - Ceasarian section - sorry. I have discovered recently (and am

now going to start to note and look into it) that having a 'cs'

delivery 'does' have a negative effect of bf.

thanks

Pam

> > I had my first ever paid for consultation as an IBCLC. Oh the

many

> > doubts that were going through my mind as I was driving to and

from

> > this mother's home. How I would have like to be accompanied by

a

> > very experienced LC.

> >

> > Had to see this mom for a slow weight gain of a 2 week old

baby.

> > Lost over 200 grams in first 7 days and is gaining only 10

grams

> per

> > day. Close f/up with baby's pediatrician is ongoing. Mother

> > supplementing with EBM. History of milk and egg allergy with

> > previous sibling so mother does not want to use formula at all

or

> > unless absolutely necessary and it will have to be a non-

allergenic

> > formula (very expensive)such as Nutramugen. This issue will be

> > addressed between mother and baby's pediatrician if needed.

> >

> > Mother had no breast size change during pregnancy and

experiences

> > minor size change once lactation has begun (goes from 36B to

36B+

> or

> > slightly fuller B-cup).

> >

> > I recommended frequent extraction with electric breastpump,

> > supplementing after every feed, modifying position and latch

and

> > breast compression during entire feed to increase flow and

quantity

> > of BM baby is getting.

> >

> > Mom will see Pediatrician on Monday and I'll be in touch with

her

> > afterwards. I'm hoping that we will see a better weight gain

after

> > 4 days of supplementation and breast compressions. Baby is

small

> (6

> > lb or 2725 g at birth) and is not sucking very efficiently.

I'm

> > hoping that this baby will become stronger and start sucking

more

> > efficiently as she will hopefully be getting more milk.

> >

> > First baby (boy) was nursed for 30 months but was supplemented

from

> > day 1 because of hospital policy regarding supplementation

after a

> C-

> > section. He ended up with nipple confusion that entirely

resolved

> > itself only after 4 months. Supply was always an issue so Mom

> > supplemented all the time. First baby was always low in the

growth

> > chart (10 % or 25 % for weight, and 50 % for height).

> >

> > I'll keep you posted on the progress of this dyad.

> >

> > Ghislaine Reid

>

>

>

[Guest guest]

Indeed, this baby was born through a c-section after a labor enhanced with Pitocin. The baby's Apgar was 8 and 10. I think baby is sleepy and sucks weakly for being underfed for 13 days.

I hope that the supplements will help improve this baby's strength and that the pumping will improve the mom's milk production. Otherwise, we'll have to look into galactogogues and possibly supplementing with ABM. Mom did want to stay away from ABM for as long as possible considering the older sibling's strong allergies to milk and eggs. Older sibling was supplemented with Soy milk.

I also keep in the back of my mind that this mom had no breast size change during pregnancy and only a slight increase in fullness once lactation began. She also experienced 3 years of amenorrhea in her twenties. No clear diagnosis was given by the doctor at that time. So insufficient glandular tissue could be a possibility.

How does one break it gently to a mom that she may be lacking sufficient glandular breast tissue ? It must be, I fear, a devastating news for a mother whose goal is to breastfeed until baby led weaning occurs. The emphasis would then have to be put on the BF relation and not on the human milk itself.

I'm anxious to see what the pediatrician will say tomorrow and I'm hoping that the baby will have gain more than 10 g per day.

I'll keep you posted.

Ghislaine Reid

Re: First consultation

Always a good idea to start with first things first - I jst mentioned 'dom' 'cos I didn't know how popular it was there. I will check the Jack Newman dosage with the 'over the counter' version here - thanks (i've only ever montioned 'dom' twice and know of one that used it!)-cs - Ceasarian section - sorry. I have discovered recently (and am now going to start to note and look into it) that having a 'cs' delivery 'does' have a negative effect of bf.thanksPam > > I had my first ever paid for consultation as an IBCLC. Oh the many > > doubts that were going through my mind as I was driving to and from > > this mother's home. How I would have like to be accompanied by a > > very experienced LC.> > > > Had to see this mom for a slow weight gain of a 2 week old baby. > > Lost over 200 grams in first 7 days and is gaining only 10 grams > per > > day. Close f/up with baby's pediatrician is ongoing. Mother > > supplementing with EBM. History of milk and egg allergy with > > previous sibling so mother does not want to use formula at all or > > unless absolutely necessary and it will have to be a non-allergenic > > formula (very expensive)such as Nutramugen. This issue will be > > addressed between mother and baby's pediatrician if needed.> > > > Mother had no breast size change during pregnancy and experiences > > minor size change once lactation has begun (goes from 36B to 36B+ > or > > slightly fuller B-cup).> > > > I recommended frequent extraction with electric breastpump, > > supplementing after every feed, modifying position and latch and > > breast compression during entire feed to increase flow and quantity > > of BM baby is getting.> > > > Mom will see Pediatrician on Monday and I'll be in touch with her > > afterwards. I'm hoping that we will see a better weight gain after > > 4 days of supplementation and breast compressions. Baby is small > (6 > > lb or 2725 g at birth) and is not sucking very efficiently. I'm > > hoping that this baby will become stronger and start sucking more > > efficiently as she will hopefully be getting more milk.> > > > First baby (boy) was nursed for 30 months but was supplemented from > > day 1 because of hospital policy regarding supplementation after a > C-> > section. He ended up with nipple confusion that entirely resolved > > itself only after 4 months. Supply was always an issue so Mom > > supplemented all the time. First baby was always low in the growth > > chart (10 % or 25 % for weight, and 50 % for height).> > > > I'll keep you posted on the progress of this dyad.> > > > Ghislaine Reid> > >

[Guest guest]

Hi Ghislaine,

This feels to me like you already said - Baby 'early?' and small with weak

suck and the delivery was not ideal - so this could improve in a week or two

when the babe has more age and strength!

The mums milk needs to brought up - perhaps a bit of super-switch feeding

combined with layers of undressing and redressing to keep the baby awake

during feeds, and encourage lots of little feeds rather than tire the baby

out with drawn out long ones. Hopefully if she mum can feed little and

often combined with pumping and feeding ebm with cup, perhaps she can hold

of on the abm for another week or two. At least the baby *is* gaining

albeit very slowly (some paeds here will allow 4 weeks to regain birth

weight as long as the feeding is improving).

I'm not sure how you would tell a mum she has insufficient glandular

material? I feel I would try the fenugreek etc. first and have a real ditch

effort, then realy congratulate the mum for doing so well and suggest that

perhpas she is the 1% that cannot provide quite enough milk - we can't

really know if it was down to lack of tissue, or the poor start being lack

of prolactin receptors for example. Perhaps offering to work with her

during the later stages of her next pregnancy so that youcan check out the

changes (she may not have noticed changes) and have a plan of action.

Good luck

Pam

Indeed, this baby was born through a c-section after a labor enhanced with

Pitocin. The baby's Apgar was 8 and 10. I think baby is sleepy and sucks

weakly for being underfed for 13 days.

I hope that the supplements will help improve this baby's strength and that

the pumping will improve the mom's milk production. Otherwise, we'll have

to look into galactogogues and possibly supplementing with ABM. Mom did

want to stay away from ABM for as long as possible considering the older

sibling's strong allergies to milk and eggs. Older sibling was supplemented

with Soy milk.

I also keep in the back of my mind that this mom had no breast size change

during pregnancy and only a slight increase in fullness once lactation

began. She also experienced 3 years of amenorrhea in her twenties. No clear

diagnosis was given by the doctor at that time. So insufficient glandular

tissue could be a possibility.

How does one break it gently to a mom that she may be lacking sufficient

glandular breast tissue ? It must be, I fear, a devastating news for a

mother whose goal is to breastfeed until baby led weaning occurs. The

emphasis would then have to be put on the BF relation and not on the human

milk itself.

I'm anxious to see what the pediatrician will say tomorrow and I'm hoping

that the baby will have gain more than 10 g per day.

I'll keep you posted.

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