I am always watchful when working with diabetics, because while some (and
this includes gestational diabetics too) bring in normal milk supplies, I've
seen a fair number struggle to normally produce in the early pp. There is
literature which discusses this phenom:
Neubauer, et al, Delayed lactogenesis in women with insulin-dependent
diabetes mellitus. American J Clin Nutrition 1993, 58:54-60.
Additonally, blood loss in excess of normal can contribute to supply probs.
(e.g. Henly, Anemia and insufficient milk in first-time mothers, Birth
1995, 22(2):87-92, and Willis and Livingston, Infant insufficient milk
syndrome associated with maternal post-partum hemorrhage, JHL, 1995,
11(2):934-938. As well as lit. on placental fragments.
In addition, there are the other issues of low infant weight (contributing
suspicion of low levels of infant stimulation due to
size/weight/immaturity). Plus the "childish" breasts. So certainly there
are many red flags for insufficiencies, some of which may be alterable,
others not. It is good she is plateauing up periodically. This may be a
sign that her homonal issues are stabilizing. Certainly it is impt. for the
baby to be fed sufficiently in the mean time.
When I see these issues combine, I work with Reglan early on, and counsel
the mom to be more assertive with MD about the bleeding. I see some of the
moms cont. to have building supplies which ultimately stabilize at normal
levels, but some just seem to have a production ceiling we can't push past.
In such situations, baby must be given other calories, and counseling,
gently, about this reality is impt. I have a couple right now with a baby
who is growing in a very borderline way. Mom is 43, fertility pt., no
engorgement phase after an operative delivery. We are 3 weeks out and baby
only grows when 3-4 oz of formula are added to the daily feeds. Mom is
worried baby has "gas." I am worried baby is hungry.
Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates, Austin, Texas
http://www.lactnews.com
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