You are caring for these families as a Stu MW, the parents are worried about their babies what can you do to support them with the challenges they are experiencing? by

Professional role and approach (NMC perspective)

2026-02-09 12:33:05 UTC

prioritise safety

Act promptly and escalate concerns

Communicate clearly and compassionately

Involve sally as a partner in care - gain informed consent and explain findings in plain language

Advocate for mother and baby

2026-02-09 12:35:36 UTC

2026-02-09 12:36:44 UTC

Born my ELCS - Higher chance of transient feeding issues & weight loss in first few days

NIPE Perspective

2026-02-09 12:37:41 UTC

Sunken fontanelle - possible dehydration

Lethargy and poor tone - concerning neurological and metabolic signs

Poor feeding with short sleepy feeds

Only one wet nappy in 24 hours

No mec passed in 2 days

Chest recession - respiratory distress

2026-02-09 12:37:49 UTC

Domperidone

2026-02-09 12:38:22 UTC

Avoid with cardiac abnormalities and arrhythmias

MDT

2026-02-09 12:38:53 UTC

Infant feeding team
Tongue tie practitioner
Health visitor

2026-02-09 12:39:33 UTC

Fenugreek is often used by breastfeeding mothers to potentially increase milk supply. While it is generally considered safe and is recognized by the FDA as Generally Regarded as Safe (GRAS), it can have varying effects; for some women, it may help boost milk production, while for others, it can completely reduce milk supply. It is important to consult a healthcare provider before starting fenugreek supplementation, as it does pass into breast milk but is believed to be safe when used in moderation. Always monitor for any adverse reactions when using herbal supplements during breastfeeding.

Signpost to:

2026-02-09 12:40:13 UTC

2026-02-09 12:40:33 UTC

Shrunken fontanelle - dehydration - urgent doctor review. Also low nappy output and urates.

Infant feeding support

2026-02-09 12:40:43 UTC

Non-judgemental and supportive

Explain to sally that Archie’s feeding pattern is not effective milk transfer and help her to understand that falling asleep quickly is a sign of fatigue or illness

Observe a full feed when safe to do so

Escalate to feeding support

EBM if possible

Hand expression or pumping to protect milk supply

MDT

2026-02-09 12:40:46 UTC

Infant feeding specialists

diabetes team

Midwifery team

Paediatric/neonatal team

2026-02-09 12:41:08 UTC

BF in first few days - cluster feeding is normal and will help establish supply

Full breastfeeding assessment - both mums

2026-02-09 12:41:16 UTC

MDT involvement

2026-02-09 12:42:01 UTC

Neonatal team

Infant feeding specialists

Practicesupervisor/senior midwife

Health visitor

Community midwife team

Possible PMHT

History taking - is Clarissa inducing lactation or is she bf a toddler?

2026-02-09 12:42:36 UTC

2026-02-09 12:42:44 UTC

Fenugreek fact sheet

2026-02-09 12:42:59 UTC

https://www.breastfeedingnetwork.org.uk/factsheet/increasing-milk-supply-use-of-galactagogues/

Sign posting

2026-02-09 12:43:09 UTC

Hospital infant feeding team

Local breastfeeding support groups

La leche league

PMHT if needed

Local children’s centres

2026-02-09 12:43:46 UTC

Did she smoke during pregnancy? If so possible oesophagel atresia?

Insulin

2026-02-09 12:44:04 UTC

Insulin cannot be absorbed orally. It will be de

stroyed in the infant's gut even if higher levels of exogenous insulin are present in breastmilk.

INSULIN IS SAFE FOR BREASTFEEDING.

2026-02-09 12:44:18 UTC

observe a full feed and take a full history, including length of feeds, feeding cues/behaviour, wet/dirty nappies
Reassurance cluster feeding is normal 8 feeds in 24 hours.
Advice on smoking around baby - offer referral to smoking cessation/tobacco dependency midwife. Avoid smoking indoors and wash hands prior to handling baby.
Monitor for signs of lethargy/dehydration/tongue tie in NIPE
Emotional support and reassurance
Encourage skin to skin contact
Follow up referral in 24 hours for support
D5 weight review if less than 10% consider referral to infant feeding
Perinatal mental health team if distress or low mood/stress escalates
Breastfeeding support groups

Advice for stimulating supply

2026-02-09 12:44:34 UTC

Nipple stimulation

Breast compression

Cluster feeding

Hand expression

2026-02-09 12:44:35 UTC

We do not know gestation of the babies, this could impact the feeding support and advice given

NIPE - TT and cleft palate should have been picked up.

2026-02-09 12:45:11 UTC

Initial assessment

2026-02-09 12:45:28 UTC

Full newborn assessment to be completed including breastfeeding assessment

Both twins on hypo policy observations

No PPH - milk supply not effected

2026-02-09 12:45:44 UTC

2026-02-09 12:45:50 UTC

2026-02-09 12:46:17 UTC

Observe a whole feed
Refer to infant feeding team
Provide emotional support/ reassurance to the mother
complete NIPE

Forceps delivery - bruising/soreness, uncomfortable to feed

2026-02-09 12:46:31 UTC

2026-02-09 12:46:49 UTC

Support with expressing and explain milk

Processes and the effects of stress and milk supply

2026-02-09 12:47:14 UTC

Hypoglycemia Observations

2026-02-09 12:47:31 UTC

The babies are at higher risk of hypoglycemia because of their mother being type 1 diabetes.

Follow your trust's hypogylcemia policy.

Signpost to Unicef for BF assessment tool, breast compressions etc.

2026-02-09 12:47:51 UTC

2026-02-09 12:48:09 UTC

both babes born by LSCS - higher chance of feeding issues + weightloss in 1st few days. BW reasonable but twins and early days = need close monitoring

2026-02-09 12:50:19 UTC

Resources- BFI/ NHS

Transitional Care

2026-02-09 12:58:55 UTC

Maybe the babies would be assigned to transitional care as under 2.9kg?

2026-02-09 13:02:11 UTC

NBT hypo policy <37/40

2026-02-09 13:02:55 UTC

NBT hypo policy >37/40