27 May 2019

MJ was a 44 year old mother who delivered a boy by cesarean section. She began breastfeeding in the hospital and was referred to me on postpartum day #5; in the 90s, people stayed in the hospital longer after a surgical delivery.

Her baby was still pooping dark colored poops; his mother reported that he slept a lot. She began to wonder if something was wrong on Day 6 when he had only 2 wet diapers in 8 hours. The breastfeeding sessions all sounded fine on the telephone: he suckled actively for 30-40 minutes, and she was nursing him whenever he wanted, for as long as he wanted. During our conversation, we identified that he was not nursing enough.

As she had bottle-fed twins 5 years ago, she expected her baby to feed every 4 hours. She was unaware that a breastfed baby may sleep a lot to conserve calories and energy, when being fed insufficiently.

(Another part of her history was that she had wanted to breastfeed her twins, but because of the cesarean section, their complicated hospital course, and the lack of breastfeeding encouragement and practical advise in the hospital led her to bottle-feed formula.)

Because the grant-funded program, A Better Start, encouraged and paid me to call as much as was necessary, this mother received daily (and for a few days)  twice daily telephone support. After 2 days of intensive follow-up encouragement and monitoring, her baby was sleeping less, waking more to feed, and started pooping yellow 3 times in 12 hours.

This telephone support is relatively inexpensive; a therapeutic relationship grew between the mother and me, and the situation resolved happily.



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