Jennifer Sholtis <[log in to unmask]> wrote:

> PTP:  I am working with a mom with a 4 month old baby, weighing 18 lbs. 
> She returned to work full-time at 6 weeks postpartum.  Her cycle returned
> at 7 weeks postpartum.  Mom pumps q2-3h for approx. 12 minutes, including
> nights.  She used to get 4.5 oz each time she pumped.  Now she is getting
> only 3 oz., and mom is very worried about her decreased supply.  2 weeks
> ago she started taking fenugreek TID, blessed thistle, oatmeal w/wheat
> germ and mothers milk tea with no increase at this time.  Mother denies
> any unusual stress at this time.  Anyone have any additional suggestions
> for this mom? Or am I missing anything?

I'm taking a guess that she's EPing and that she needs to EP and can't
nurse, but you haven't said. By my calculations, that's 27-30 ounces a
day - is that not enough for her baby? If not, is milk being discarded
unnecessarily? Is the baby being "encouraged" to finish bottles when
they're not wanted? Is she preparing too-big serves? Does she have a
freezer stash?

If she does need more, then back to basics, not just piles of added
herbs and spices. More skin to skin time with the baby. Increase pumping
time to 15 minutes. Make sure that a double hospital-grade pump is being
used, and that the pump is in good order and correctly assembled. Change
the valves - pinholes in valves or overstretched valves can cause a drop
in vacuum. Make sure that flanges are the right size - size needs can
change over time. A comfortable stretchy pump bra, warmth on the breasts
just before or while starting to pump (a warm but not hot wheat bag can
be useful). Compressions while pumping, hand expression after pumping. 

Make sure that mum isn't doing anything obvious that might decrease
supply (eg hormonal birth control, meds containing decongestants). When
did this decrease start to happen? Is she about to have a period? Could
she be pregnant again? I do have to wonder at her cycle returning at
seven weeks while she was pumping around the clock and getting enough
for a baby-and-a-half... that's unusual, but I guess unusual things
still happen.

Lara Hopkins

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