Hi Liane,
I'm sorry no one answered you earlier. Yours is one of those situations with
no clear cut solution, but you seem to have a good plan in place.
If I was working with this client, I would be thinking that if she has
enough milk to nurse a 21 mo old 3x a day, she'll probably be ok with the
new baby.
Although I do realize (from professional and personal experience) that when
nursing an older child, sometimes they are nursing "dry" at the end, but
usually
not so early as 21 months.
I would seriously take into account her tubular breasts, but more so her
history of low supply in the early months. I would recommend that she start
out
optimally, which would be initiating within the first 1/2 to 1 hr after
birth, no separation, frequent feedings. I would consider having her express
her milk in
between feeds, especially if the baby is sleepy or otherwise not nursing
actively. This might be more than is needed, but I'd be inclined to be
pro-active, rather
than finding out in 3 or 4 days, that we needed to do something. So if mom
is willing, I'd ask her to express from day one. Give that to baby with a
spoon.
Then on day 3 or 4, if mik supply does not "kick in strong" then I would
consider galactagogues. She certainly can supplement if signs indicate their
is a need, with
feeding tube at breast.
She can be reassured that her supply does seem to respond over time, and she
can look forward to a normal course of nursing (years) for the new baby too.
Laurie Wheeler RN MN IBCLC
Mississippi USA

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