> Help! I have a NICU mom who had triplets via C-section 17 days ago (they
> were 30wk + 5 days at delivery) and she cannot produce more than 1/2
> ounce of milk per pumping session yet

> Aack! Are we missing something???????

Retained placenta? What's her lochia looking like? I had a mom-client once,
sounds just the same but c-section for twins, and at 8 weeks postpartum "no
milk" to speak of, but still spotting red on a mini-pad. I kicked myself for
not thinking to ask sooner -  sent her in to her OB - D&C was done and a
small placental fragment no bigger than the end of her thumb had been inside
churning out progesterone. It was like magic getting rid of that placental
fragment! Milk gushed within 48 hours...

You said she is "drinks plenty of fluid" - the key isn't so much her intake
as it is her output. If she is urinating at least every 2 hours when awake,
then her kidneys also believe she has enough fluids. Otherwise, maybe she is
still dehydrated (in the opinion of her kidneys, that is, and they are Boss
over Things Hydration).

The other thought is her fatigue levels, which will cut into supply faster
than anything I know. Though she says she is rested, twice daily visits may
be putting her over the top at only 17  days post-partum triplets, not to
mention being post-op as well. Is she pumping every 3 hours through the
night too? If so, encourage her to catch up on her sleep for 2 mights (only
pump if her breasts wake her up and ask for it) and see what happens. I have
had great results with this approach in this kind of situation. (In fact, I
find that NICU moms don't really need to bother with nigthtime pumping, if
she can get in 8 pumpings otherwise, until a week or so prior to baby's
discharge. At that time, resume night pumpings to "wake-up" the breasts for
nighttime production - I know this is tantamount to lactation consultant
scarilege, but I have had great results - and sane, well-rested moms in the
process!! So there it is!!)

I have 2 more weeks before I have to go NoMail again, and just had to jump
in on this one. Good luck!

Katharine West, RN, BSN, MPH
Sherman Oaks, CA
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