I would tell this mom to hand-express AND pump. A LONG time ago, there was research showing that with more babies, there is a need for more stimulation/milk removal sessions. Even Paula Meier's research showed 10 or more sessions are important until copious milk production occurs. And it can take longer for that to occur. Encouragement and patience is vital. I have seen moms require 8 weeks of intense work to get to the point of making an "adequate supply" AND then have OVERSUPPLY! Isn't the human body amazing?
And while I'm here, I just want to remind myself that breastfeeding is so much more than nutrition. We have downplayed because we don't want to offend the bottle-feeding mother, but REALLY if we look closely at it, isn't part of the obesity problem the substitution of an unhealthy behavior for emotional and psychological connection between mother and child that occurs with breastfeeding EVEN IF there's a supply issue? And normative nursing period (2 years or so) allows the child to transition from mother as source of food to mother as source of emotional security and love, the being-thereness that is the definition of love. And that being-thereness continues after weaning and beyond. This emphasis on emotional detachment and self-sufficiency that I see in psychology and child rearing books is ridiculous. It's a house of cards. I think it is a delicate balance to maintain that exclusivity and extended breastfeeding must work hand in hand and our efforts must promote one without undermining the other!
-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Breheny, Denise
Sent: Tuesday, December 21, 2010 8:12 AM
Subject: Triplet mother
I need the assistance of the group wisdom. I have been a reader of LACNET for years, but haven't posted in about 10 years. I have a patient that I am working with, that is having problems with her milk initiation. I have her permission to post this email. She is 34 YO, professionally a nurse anesthetist. G3 P3, She delivered natural triplets on 12/15. She was started pumping within 12 hours of delivery (I know this is late, but for this hospital is very good), and since has pumped an average of 8 times daily with the preemie programmed symphony. Her Triplets were 34 weeks gestation and a good size at 2.0, 2.4 and 1.92 K. Her previous deliveries were in 2009, and 2007. With both previous children she had a solid milk supply which came in quickly. She breastfed the first for 8 mos, and pumped for an additional 4 mos with enough surplus milk to last over 2 additional months. With the second baby she nursed for 14 mos. At day 5 yesterday, she is still only pumping drops to the largest volume of 10 mL.
Her pregnancy was significant for anemia and she received several iron infusions, at delivery her hemoglobin was 9.8. Her breasts are soft, with no indication of filling. She has some dependent edema, most notable in her ankles, but nothing really outrageous. I am stumped? Why isn't she getting her milk in? Please let me know what you think, or what to do.
Denise Breheny, RNC-MNN, IBCLC
Charlotte, NC
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