Dear Lisa and All, here is a clinical situation that I am aware of .... I
have permission to post. If anyone has input, please send to the list, and
to me privately. Thank you! Kathleen
Kathleen Bruce RN IBCLC
Independent consultant: Breastfeeding Clinic of Vermont, Lactation
Resources of Vermont, Medela, Inc. Listowner Lactnet listserv
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Third baby (fourth pregnancy); full-term (40w3d). Short labor attempt for a
VBA2C, with no progression, followed by c-section. Birth weight 7 lbs 13
oz, 20 in. Baby and mom separated for approx 90 minutes post-birth, after
which baby latched beautifully and swallows of colostrum were easily
audible. Wet diapers and meconium the next few days. Milk came in
somewhere around day 3-4. By day 9, although birth weight regained, baby
did not seem to be having diapers as wet as in the previous few days, and
exam by IBCLC found low oral-motor tone. Referred to an oral-motor
therapist with follow-up exercises dutifully performed.
Baby has gained well; by 4 months she was 18 lbs, by 6 months, she was over
21 lbs. At 9 month checkup, she's still between 21-22 lbs. I know it's
normal for their weight gain to taper off, but I also know my supply is not
stable, and that it fluctuates to extremes.
Since nearly the beginning, I sometimes have long-lasting periods (up to 2
weeks) of low supply - diaper weights during one particularly bad day (part
of a streak of about 7 days of low supply) in January were, over a 12-hour
period: 2.1oz, 2.3oz, 2.4oz, 2.5oz, (2)2.8oz, and one decent 4.3oz
(overnight diaper)...including a wipe in each of them (a new diaper weighs
1.4 oz). And as right now, when we are in a supply slump, one diaper could
just about be used for an entire day (if one were inclined to wait that
long; they just don't get wet). Stress is not a supply-buster - at least,
sometimes, extreme stress (such as the impending hurricanes we had last
year) seemed to make things better, but other times, I didn't notice a
change.
Curiously, sometimes, but not always, these low supply periods are followed
by periods of engorgement and extreme breast fullness and pain, and baby
gulps, pulls off because of the very fast flow. That hasn't happened in
about 2-3 months, and as well, the low supply days are more frequent and
longer-lasting than earlier.
Baby does not take a bottle, has never been supplemented with formula, and
consumes little to no solid food; she gums it, at most, and spits it back
out. She is sometimes willing to take a sip of water from a sippy or sports
bottle, but nothing measurable.
Lactation history: Baby #1 - full-term, scheduled c-section due to presumed
CPD. He was breastfed with NO problems; I had an ample supply and actually
discarded over 300 oz of frozen breastmilk when he was about 15 months old.
He was breastfed through my second pregnancy and last nursed when he was
just past 3 years old. Baby #2 was full-term, a scheduled c-section due to
transverse lie. She was breastfed until I became pregnant with baby #3, but
similar to this time, my supply was up-and-down frequently. I often thought
it was because she seemed to have some oral aversions possibly due to being
deep-suctioned at birth. If it matters, I have never leaked breastmilk,
except one time when my first child was nine months old. Sometimes, on the
very low supply days, it seems that part of the problem is that I simply
have trouble letting down, especially on one side.
Medications: I took domperidone from the time baby #2 was 4 months old
until she was 16 months old. I also took fenugreek, blessed thistle, red
raspberry leaf capsules, marshmallow and alfalfa. I still experienced the
up-and-down problems. Same as now - I've been taking fenugreek and blessed
thistle since about 3 weeks post-partum. A few times, things have been good
enough for a long enough time that I'd wean off of them, but my supply would
eventually spiral down. I started taking domperidone in March of this year;
I can't say it's really helped. I'm also taking fenugreek, blessed thistle,
and I recently added alfalfa and fennel; I usually have a bowl of oatmeal
for breakfast. Previously, I took goat's rue and More Milk Plus (from
Motherlove Herbals) for about 4 months, with no greater success at
maintaining a stable supply.
Medically, I am healthy, except that I'm overweight. I've been that way
while nursing all three kids, though, so there's not much that's changed. I
recently saw an endocrinologist, hoping that he might do some testing as I
wonder if all of this is hormonal. He suggested I wean the baby, stop
taking the dom and herbs immediately, get bloodwork in a month and come back
in six weeks. While I'm curious about the hormonal
aspect, what I really want is to find out what's causing this, and I am
especially keen on finding a solution that will preserve my nursing
relationship with my baby. My LC suggested that in some cases, metformin
has helped *some* women, and I wondered if I might have an asymptomatic case
of PCOS, since other than my weight (which, by the way, I lost 86 lbs just
before this last pregnancy, and regained during and after the pregnancy), I
have no symptoms. Menses returned once, at 7 months post-partum, but hasn't
been back since starting the dom.
I nurse my daughter every 1.5-2.5 hours; we co-sleep and she latches 3-5
times during the night. I drink plenty of fluids, and have a healthy diet.
I've tried many of the tried-and-true suggestions for low supply, but they
seemed to be aimed at singular, out-of-the-ordinary events and not repeated
supply fluctuations. I'm at a loss as to how to resolve this very
frustrating problem. Baby is now 10 months old, and I fear we'll have to
limp along until my body just stops making milk at all.
___________
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