I recieved a call from a nurse midwife who presented the following: A
gravida 5 para 4  who is in her 18th week of pregnancy.  With all of her
children, her milk didn't come in for 10 days.  The babies lost > 10% in
weight and she had to make frequent visits to the pediatricians office for
weight checks.  She is hoping to avoid this this time around and wondering
if there is anything that can be done now or immed. postpartum.  Even though
she is expecting this to happen again, it's still anxiety producing of
course.  I had the chance to talk directly to the mom and she provided this
info.  She does 24hr. rming in and goes home in 24 hrs.  All breastfeed
right after delivery and the recommended frequency afterwards.  Her
deliveries are vaginal with no postpartum hemmorhage or other complications.
She did say that she loses weight during pregnancy because she has no
appetite but with lactation gains 30-40 lbs. Her appetite is voracious right
after delivery.  I asked about her thyroid and she thinks it was checked
last year and diabetes screening was neg. All the babies are 8 and 9 lb.
term kids and never have shown signs of dehydration because of slow
production even at the furthest time out.  They are alert, active and all
seems to turn around as far as weight gain is concerned after the 10 day
mark.  Mom nurses for an extended period ( 2 yrs. ) and is either pregnant
or nursing.  Are we looking for something that isn't there and could this be
normal for her especially if her babies do well ?  We plan to meet together
next month at her office visit.  I am asking for your ideas and input on
this one.  The info I have gained from "looking in" before is invaluable.  I
look forward to your responses.


Laura Walker RNC, IBCLC
Johnson City,NY
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