NB: Picture not of baby described above, names removed to protect patient confidentiality

Summary: 2^nd baby, 1^st baby had 3L Postpartum Haemorrhage, 2x transfusions, BF until 9 weeks. Elective c-section (despite going into spontaneous labour so emergency done overnight) this time due to traumatic birth with complications. Expressing colostrum for the first few days. 2x 10ml top ups given. BW 3650. Day 6 3360 down 290 grams 7.9%. 3340 down 20 grams in two days. Weight post formula 3420. D11 3480 increase 60 grams (170 grams below BW). BF during the day, 1x bottle O/N. Last 2/7 days bottle after every feed 30-60mls. Started domperidone 1 tablet 4 times a day on Sunday. Not pumping. Hx PCOS, no fertility issues, no breast changes during pregnancy (good post delivery). No thyroid issues, no mini pill. Mum BF well. Yellow poo, most feeds (small to large amounts). Waking 3hrly for feeds, regularly.

IMPT: Low supply secondary to short, sleepy feeds and top ups. Plan is to increase supply.

PLAN:

Domperidone – continue.

Ensure deep latch – chin to breast, nipple to nose.

Breast compressions to keep her actively feeding. 

Listen for swallows and milk transfer.

Switch feeding – move side to side to keep her actively feeding.

Seeing LMC for weight today – needs to be back to BW by day 14 or discuss with LMC re paed referral.

Intensive pumping – 48 hrs if you can manage after feeds to boost supply.

Top up as required - 150mls/kg/day = 540mls – 67.5mls (offering 570mls).