My name is Jennie Walsh.  I am a second semester junior nursing student
at the University of North Dakota.  I am starting my OB and pediatric
clinical rotations this fall.  I have been a member of this listserv 
for a few weeks, and have really enjoyed reading about the nursing
mother and infant.  I enjoy OB, and hope to work in the area when I
graduate.  I am writing in regards to initiating breastfeeding, and 
having adequate milk production.  I have been asked by a new 
mother, "Why can I only produce 1-2 oz. of milk from both breasts when 
I pump?  I am doing so several times a day."  She wants so much to 
breastfeed her daughter, but through nursing and pumping, the baby is 
not getting satisfied.  How can I encourage her to keep trying, when 
she is so
discouraged?  Is this normal as a first time mother to produce so
little?
According to Eideman et al.,(2005), during the early weeks of 
breastfeeding, mothers should be encouraged to have 8 to 12 feedings at 
the breast every 24 hours.  The mother should offer the breast whenever 
the baby shows signs of hunger, such as increased alertness, physical 
activity, mouthing or rooting. 
According to Abinona et al.,(2005), if milk removal does not occur at 
about day 3 postpartum, milk secretion will typically decline.  The 
length of time and the amount of feedings on day 2 are associated with
how much milk will be available for day 5 feedings.  
Denk, Kruse, Rotondo, & Winter (2005), report how crucial the first 
hours are after delivery to initiate breastfeeding.  The authors state 
there is a critical window, that an infant should be
placed skin to skin with the mother immediately after birth.  If the
relationship between mother and child is not established right away, 
the chances of exclusively breastfeeding the child may be decreased.
I understand the number of times she ought to be trying is great. 
Should she put the baby to the breast more often?  Should she continue
to pump and still supplement with formula?  Thanks for your time.

Jennie Walsh

Abiona, T., Campbell, S., Dodgson, J., Gill, S., Heinig, J., & Wambach,
K. (2005).  Clinical Lactation Practice: 20 Years of Evidence Journal 
of Human Lactation 21(3).pp.245-253
Denk, C., Kruse, L., Rotondo, F.,  & Winter, L., (2005) Comparing
Sociodemographic and Hospital Influences of Breastfeeding initiation.
Birth 21(2).pp.81-85
Eideman, A., Gartner,L., Lawrence, R., Morton, J., Naylor,A.,
O'Hare,D., & Schanler,R.(2005)
Breastfeeding and the use of Human Milk.Pediatrics 115(2) pp. 496-506

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