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Hello wise women....I'm hoping for some help with a dyad I saw yesterday. Mom his large breasted and had a reduction three years ago. At the time of her surgery they also everted her nipples which had been inverted with her first two babies. Now they just look flatish. She seems to be producing well and can pump about an ounce per side in 20 minutes with a little bitty handheld Medela. Saturday was day 3 postpartum. Baby is losing weight. She had never latched until my visit on Sat, but according to my scale she only transfered two tenths of an ounce per side. Her oral structures look fine -- mom is compressing during feeds. Baby looks to latch well (she comes off several times per feed). I'm going back to follow-up tomorrow.

Dawn

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Did you try adding a Lact-Aid ? Maybe if the flow is greater the baby won't be coming off.

Ghislaine

What else....?

Hello wise women....I'm hoping for some help with a dyad I saw yesterday. Mom his large breasted and had a reduction three years ago. At the time of her surgery they also everted her nipples which had been inverted with her first two babies. Now they just look flatish. She seems to be producing well and can pump about an ounce per side in 20 minutes with a little bitty handheld Medela. Saturday was day 3 postpartum. Baby is losing weight. She had never latched until my visit on Sat, but according to my scale she only transfered two tenths of an ounce per side. Her oral structures look fine -- mom is compressing during feeds. Baby looks to latch well (she comes off several times per feed). I'm going back to follow-up tomorrow.

Dawn

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Dawn states: " Baby looks to latch well (she comes off several times

per feed... "

What happens when baby lets go? Is she sputtering, or anything like

that? I was thinking that if mom can get that much milk from the

weaker pump, maybe she has an over-active let down which baby can't

keep up with...odd for a reduction though...just thinking out loud...

What else? Hmmm...What does her latch look like? Deep enough? How

about with digital oral assessment? Does she gag with the finger

shallow? Organized suck? Term baby?

I would suggest that mom rent a hospital grade pump to protect her

milk supply while all of this is getting ironed out...she may have had

a good result with her little hand-held initially but that won't last,

especially w/ a reduction.

Getting ready for the exam...butterflies in my stomach everytime I

think about actually sitting down and getting my test booklet.

Yikes! Send positive vibes my way please! (I'm testing in Honolulu;

anybody else over there? I'll change islands on Sunday...)

Mahalo, lee Hulburt (from La Jolla,CA)

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Thanks to those of you who responded. On Sunday I called to see how things were going, didn't get an answer but left a message. On Monday I sent an email with some follow-up suggestions and a request to set a follow-up. On Tuesday afternoon I received a response from the mother -- claims the baby is too lazy to nurse and she's decided to pump and bottle feed. I've sent a follow-up email that she should consider a hospital grade pump and the equation for appropriate intake (baby had lost significant weight). I find this sad -- baby was a C/S after a failed induction at 37 weeks for PIH. I tried explaining to mom that her baby wasn't lazy, she was a little early (oh no the doctors said she was term and was just fine), probably befuddled by the medications (why I'm not feeling them anymore), and needing to practice at the breast. Oh well -- we can't win them all -- I did a consult last night with a mom of a 6 week old who really just wanted reassurance that everything was okay -- it was, great nurser, great gainer, nice family -- I'll focus on this little guy who will be breastfeeding for a good long while.

Warm Regards,

Dawn , IBCLC, CD(DONA)

Austin, TX

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