Section 5: Integrative Case Studies
4 Case Studies
Case Study #1: Weight Loss and C-Section Births
The pediatrician is rounding on a baby, day 3, born via c-section for “failure to progress” after 34 hours of labor induced at 38 4/7 weeks gestation for LGA. The mother is a G2P1 who plans to exclusively breastfeed.
RN: I need to update you on this baby before you go in to examine her. The baby’s weight loss is 10% today.
Pediatrician: That is a significant change since yesterday’s weight loss of 6%. I am concerned.
RN: I have been working with this couple since yesterday, and I believe breastfeeding is going much better in the past 24 hours.
Pediatrician: We may need to consider supplementing with formula in order to prevent any further weight loss.
RN: Breastfeeding is going well so I don't think supplementing is needed for this couplet. This mother was in labor for quite a while, she received between 4 and 5 liters of fluid between the time her epidural started and when she finally delivered via c-section the next day. She breastfed her baby 9 times in the past 24 hours. Since yesterday, feedings have been more effective with audible swallowing. The last stool was transitional. Mom is reporting that her breasts are feeling heavier.
Pediatrician: The weight loss is concerning, but it sounds like the IV fluid volume may have been the contributing factor. I am reassured because it sounds like breastfeeding is progressing and I am happy that the baby is transitioning and doing well.
RN: Yes, I believe some of the weight loss is due to the volume of IV fluid that mom had during labor and delivery. Mom has started expressing milk by hand. After she breastfeeds her baby, dad spoon feeds the expressed milk to the baby. After the last feeding, about one hour ago, she expressed ¾ cc. The parents plan to exclusively breastfeed and I think the plan will help them achieve their goal and will address your concern about weight loss.
Pediatrician: It sounds like you have put together a good plan. As long as everything continues to progress, then there is no need to supplement with anything other than breastmilk. During my assessment, I will reinforce all of the positive indications that breastfeeding is going well. Does mom plan to go home tomorrow?
RN: Tomorrow is her planned discharge day. I did talk to the parents about the possibility of discharge being delayed, depending upon the weight loss. We also discussed the importance of discharge follow-up and breastfeeding support. She is planning to make an appointment with the outpatient lactation clinic the day after discharge.
Pediatrician: I will also talk to her about the importance of scheduling an appointment with me in the office within 24 hours after discharge.