Encouraging her to keep the pumping up 8 to 12x -- it would be great to 
have a food or pill that just makes milk, but those relentless removals 
are the rock-bottom necessity.  . Acknowledge that it's discouraging to 
not be seeing big output at this point..  Sometimes it helps to think of 
it as "placing the order."  Sometimes when the body has had such a 
shock, with the c-section and blood loss, the milk volume change isn't a 
dramatic "coming in" but a slow building -- it seems that the body is 
first putting its resources into her survival, and then as the recovery 
proceeds, the body can divert energy to this new activity of 
milk-making.  Brainstorming with her on ways to make the pumping 
practical.  With tiny NICU premies, she'll have to be more scrupulous 
about clean pump parts each time, so having a few kits (with properly 
fitting flanges) and a hands-free rig, either purchased or home-made, so 
she can multi-task the pumping,  get some rest while pumping, and do a 
lot of massage and compression.  Lubricate the flanges.  Some mothers 
prefer a pumping schedule, while many do better realizing that babies 
don't feed at regular intervals so she can cluster some closer together, 
but not to go longer than a 3-4 hour stretch.  There is no bad time to pump.

Multiples are a challenging situation -- the underachievers with just 
one baby are feeling overwhelmed in those first weeks.  When people are 
tired and stressed, they are prone to want to solve things with "all or 
nothing" thinking, so trying to find strategies that help her stay in 
the game -- even if it's not perfect, everything she is doing is good -- 
any amount of breastmilk and eventually breastfeeding will be a good 
thing for her babies.  She hasn't met her babies six weeks from now.

As the babies' condition permits, skin-to-skin sessions, and practice 
sessions at the breast if the baby bobbles around toward it,  will be 
wonderful for welcoming them to the world, and may give a hormonal boost 
to the mother that the pump, though a useful tool, just doesn't provide 
as well.

Women eating very different diets around the world make milk, so she 
shouldn't feel she needs a special diet -- though a year from now, these 
babies will be eating at her table, and many people need to improve 
their diets.  But anyone after surgery and blood loss needs nutritious 
fortifying foods.  A lot of old wives did a lot of breastfeeding, so 
there may be a lot of wisdom in traditional lactogenic foods, some of 
them very iron-rich -- oatmeal, barley and quinoa, dark green leafy 
vegetables (kale, collards, beet greens), eggs, healthy fats, seeds like 
sesame, chia, flax and sunflower. Among the herbals, nettle and 
mulunggaay are iron-rich.  The book "Making More Milk" has lots of 
information, and may make her feel that she's on some common ground.

Good luck to the whole team.

Margaret Wills, Maryland


Date: Wed, 5 Jun 2013 17:00:57 -0600 From: Erika Lance 
<[log in to unmask]> Subject: Blood loss and little milk I have a 
client that has given birth by cesarean and multiple births. Because of 
the high profile case all I am going to say is that she has had more 
than twins. She is pumping 8 times a day and getting very little out. 
Perhaps a half ounce. The babies are big considering and healthy. I am 
assuming because of the blood loss during delivery. Nutrition is not my 
strong point... any ideas of what she had eat in her diet or any other 
suggestions to help increase. Thank you so much!! Erika Vance 
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