First time mother in crisis

[@llli*beth.a.mck]

My daughter, Erica, had her first baby 8 days ago. She is committed to breastfeeding and they were doing fine. Erica has ample breasts and had more than enough milk except that she is both constipated and throwing up since Saturday. She hasn't been able to keep anything down, she is in constant uncomfort and pain, and is nauseous all the time.

Sunday she started developing a painful hard spot in one of her breasts. Luckily she had an appointment with a lactation counselor on Monday. The lactation specialist DID help her with the hard spot and Erica now knows exactly what to do if that happens again, so that was a plus.

The lactation guide also gave her some kind of stool softening medication which she threw up later on that day, so Tuesday we called her and she recommended milk of magnesia which was thrown up. That night we tried a liquid suppository and there was a little success but not nearly enough. Wednesday we spent 8 hours in Salem Hospital Emergency room to make sure she wasn't impacted. She wasn't. They gave her anti nausea medicine which she threw up. They think she has the flu and gave her an IV bag to rehydrate her. She asked for a second one which they gave her and wanted a third, but it was midnight and she wanted to go home more. That IV helped for a couple of days.

She has been sipping water, using Gatorade ice chips, ginger ale over ice, her husband's excellent soup broth, but everything comes back up. Thursday night she decided to force lots of liquids down so at least she wouldn't have the dry heaves and it seemed to work. Yesterday she tried forcing Ensure down. She got half a bottle down in the morning but couldn't stomach any more, but she didn't throw it up and we thought she was on the mend. She was able to drink a little more and then last night she threw everything up.

She has not had anything solid to eat since last Saturday and is loosing weight too quickly. She has been fighting as hard as she can to keep breastfeeding, but her milk supply is drying up and she is sleep deprived, listless and hopeless and the thought of spending another 8 hours in the emergency room for some more IV is impossible. Please help us hydrate her. We are at our wits end.

I am sending this message out to as many people as I can think of, so you might hear about us through other people. Thank you.

[@llli*maddieb]

Hi beth.a.mck. I am so sorry this is happening- you must be so concerned about your daughter!

I am not a doctor, but after experiencing extreme nausea and epic constipation (including getting impacted once) after each of my c-sections, I do wonder if birth complications/meds reactions have been ruled out? Also, if mastitis (breast infection) has been ruled out. (BTW the only thing that got me to stop vomiting the last time was 2 teeny pills they put under my tongue. Sorry I cannot remember what those were called but I do know it took the hospital staff 24 hours of me barfing up the kitchen sink to even consider them. Maybe they were old school or something.)

Ok, not being a doctor and also having no idea what is wrong with your daughter, here is what I suggest from a breastfeeding perspective. A mother does not have to be one hundred percent healthy to breastfeed. Unless, for her own health, she has been medically ordered to not nurse or pump at all, (and I would question the wisdom of that especially as she had that plug - not nursing could easily lead to mastitis) then she can still nurse her baby while getting treated. Almost all medications are safe to take while breastfeeding, if she wants specific information about a specific med the best source is these folks: www.infantrisk.com. You can call them during the week, and they also publish a book called medications and mothers milk in which meds can be looked up. The hospital SHOULD have it, asp the Lactation Consultant.

Then, here are the guidelines for when a mother is not able to nurse or exclusively nurse baby:
1) feed baby
2) protect milk production
3) seek breastfeeding help

In this case, number one might mean that if mom is not making ENOUGH milk for baby, baby can be supplemented (with donor milk and/or formula, whichever is available and mom is most comfortable using.)
#2 means, mom should continue to nurse her baby as much as she is able to, and/or pump. BUT, With mom being very ill, her health must be considered. On the one hand, for best milk production, it is typically reccomended that milk be removed from the breasts (by pumping and/or baby) a minimum of 8 times a 24 hour day. On the other hand, if mom can't do this without endangering her health, she can do as much as she can do. btw it is best if a hospital grade rented pump is used for pumping in these kinds of situations, typically.

Even if baby is getting supplemented and mom is pumping, it can be very helpful if baby can be nursing as well- at least once a day, preferably more.

Any supplements can be given in a breastfeeding supportive way. A lactation aid (at the breast supplementer) is really best, assuming baby is able to latch and mom is up to it. A lactation aid allows baby to be supplemented while nursing.

However, this is a situation where others may need to be feeding baby some of the time? In that case, cup feeding, syringe feeding, or paced bottle feeding would all be appropriate.

Week old babies tend to nurse about 12 times a day and take in small amounts at a time. 1/2 ounce to 2 and a half, typically. So supplementing baby in a similar manner is helpful.

Once mom is well, there are many techniques to increase milk production she can try. There are foods and herbs and even medications that increase milk production. So while yes, this is a vital time when milk production is normally increasing and it is important to optimize that as much as possible, the fact is, your daughter will probably be able to increase her production at least somewhat (and possibly a lot) down the line if that is necessary. Will it be enough for baby to exclusively nurse again? That is unknowable. But many mothers who have low production still nurse for a long time while supplementing as needed. My point is, this need not be the end of breastfeeding. The suggestions I have given will, I hope, improve the chances she will be able to nurse & even exclusively nurse her baby for as long as she wishes. What is most important at this point is that your daughter get well.

when i get a chance i will link some info on the devices and techniques i have suggested.

[@llli*maddieb]

What is normal in the early weeks with a breastfed baby (will help everyone understand what is normal and what is not. Sometimes supplements are given unnecesarily. Watching output can help) http://kellymom.com/bf/normal/newborn-nursing/

Feeding cues: (helpful for anyone feeding baby) http://www.llli.org/docs/00000000000...eding_cues.pdf

Diaper log (for tracking poops-output) http://www.llli.org/docs/00000000000...diaper_log.pdf

Waking a sleepy newborn: http://www.llli.org/docs/00000000000...py_newborn.pdf

Paced bottle feeding

Information sheet: http://www.llli.org/docs/00000000000...astfedbaby.pdf Video: http://www.youtube.com/watch?v=UH4T70OSzGs (Don’t worry about what she says about time between feeds- typically, best to cue feed whether nursing or bottles.)

cup feeding Cup feeding at the breastfeeding clinic, shows the mom with breasts exposed: http://www.nbci.ca/index.php?option=...lips&Itemid=13

For optimal milk production, nursing is usually better than frpumping. But if mom cannot nurse, she can pump. She should not worry how much she 'gets,' unless there is an indication of pump malfunction. Hand expression along with pumping can be helpful as well. If there is no pump avalilable and baby cannot nurse, hand expression can be used. Pumping chart: http://www.llli.org/docs/00000000000...umpigchart.pdf hand expression:http://www.llli.org/docs/00000000000...expression.pdf


These tips are for a different situation-the baby who cannot nurse-won't latch. However, some may be helpful adjusted for your daughters situation.
http://www.llli.org/docs/00000000000...ching_baby.pdf

I hope this is helpful. Please let us know if you need more info and keep us posted if you can.

[@llli*mommal]

. (BTW the only thing that got me to stop vomiting the last time was 2 teeny pills they put under my tongue.

Was it phenergan? I know that is used to control severe nausea.

Often medical professionals don't know the correct answers about medication safety during breastfeeding. If your daughter is prescribed any medications, she should double check their safety with Infant Risk (http://www.infantrisk.com), particularly if she is told not to nurse while taking a certain medication.

[@llli*maddieb]

Was it phenergan? I know that is used to control severe nausea.

I don't know. And I am sorry but my bill does not say and I don’t have my medical records. All I know is I was vomiting non-stop, they kept trying something in my IV, then a suppository, and then finally those two little pills which dissolved in second under my tongue and and I finally stopped heaving. Like, immediately.

I also had terrible nausea during pregnancy, and I was given Reglan when I was pregnant with my first baby 10 years ago. It helped a little. I think it is no longer considered safe during pregnancy but should be ok past partum. Interestingly, it is also helpful for low milk production-it's a galactagogue. But there are some risks, I think moms at risk of depression should not take it or at least not for long.

Some OTC anti-nausea things that work for some people are Sea Bands (You wear them on your wrists and they apply pressure to your pulse point and that lessens nausea-you can get them at the drug store.) I also liked "preggy pops" - Flavored lollypops that contain ginger, an anti-nausea herb. Both the sucking and the ginger helped me, a little.

I drank citrus flavored sodas- San Pellageino, Oranginas, that kind of thing. It was the only liquid I could keep down for months with number three.

Water makes nausea worse. Salty, crunchy things like the classic cracker or tortilla chips can help.

Is she still constipated? That is also no fun and kind of concerning to me.

If she needs IV fluid, isn’t there a way for that to be done at home?

[@llli*froggylogic]

You've gotten some excellent advice on how to continue breastfeeding during this period. I think maybe lllmeg is thinking of zofran? It's a kick-@$$ anti-nausea that dissolves under the tongue.

I would urge you to urge your daughter to seek more medical attention. Go to her regular doctor if she doesn't want to visit the ER again. Severe nausea and vomiting for a week is not the normal pattern for a stomach virus (I'm not a medical professional, but speaking as someone who has had more than her fair share of stomach viruses that required ER trips). Something is not right and she and her daughter deserve to have it looked into.

[@llli*lllkaren]

So, Erica started throwing up the day after her baby was born and it has gone on for a week now? Did they run any tests when she was in the ER? Or has she contacted her OB/GYN or midwife?

It just seems like an awfully long time to be vomiting. I would suggest she get checked out again, just to make sure there isn't something more serious going on.

[@llli*maddieb]

I think it was zofran. That sounds right.

I agree about getting more medical attention. Something sounds very off.