I have a client (first baby) who is *very* thin.  She is about 5'4" inches
and weighed 96# before pregnancy.  She gained up to 120 in the first 6
months and gained no weight in the last 3 months.  I asked her why she
thought that she gained so little and she said that she was busy and had
too much going on to eat well. I don't know what her present weight is.
Baby weighed 5# 8 oz at birth, but doesn't look like a "healthy" 5# 8oz.
There was change in breast size during the pregnancy.

I was called in due to insufficient output. I saw them on day 4 and baby
latched better.  With a lot of breast compression baby did some swallowing.
 Breasts had grown "lumpy" and fuller, but baby wasn't drawing the milk out
on his own.  His mouth was dry even after his time at the breast.  Mom
began supplementing.

It is now day 6 and no sign of more milk. Mom tried pumping, and in 15
minutes there were about 3 drops on the flange of the pump.  Rescue Remedy
didn't stimulate a MER.  She then tried hand expression and, after 10
minutes one breast was wet on the nipple and the other had a few drops.

I have 2 (at least) questions.  Should she continue pumping? Should she
spend time hand expressing, even those few drops?  Baby was suckling rather
well on Monday, but with supplementing with spoon, then supplementer at
breast, he is not enthusiastic about the breast, where there is not much
reward. His suck at the breast is not good now because he seeks the tube.

He will be a week tomorrow.  Have any of you seen beginning milk production
after this long?  Seems as if I remember someone telling about a delayed
milk production. Mom is taking More Milk and Fenugreek and eating oatmeal.
There seemed to have a beginning of swelling of tissue for milk production,
but it stopped.

I have read the studies that say that mother will make milk even if she is
malnourished, but the lack of weight gain in the last 3 months of pregnancy
concerns me. She looks like a woman who has a poor relationship to food.  I
asked about eating patterns in her life, and she didn't tell me of any
problems.  I wonder, though.

She also has the demeanor of a "child."  She is fragile, moving slowly and
cautiously, seemingly helpless. It's hard to describe what I see, but it
seems to be a reluctance to "let go."

The archives has stories of women who were anorexic who went on to make
plenty of milk, but the cases were about past history. There are a couple
of posts about cases similar to this one, in which mom doesn't make much
milk. What have you found with a recent history of food deprivation?
Should I ask her more directly?  I fear that I will just heighten her guilt
if she did eat poorly in the last trimester. Or would coming to a "cause"
be of benefit for other babies?  Should I continue to work on her supply,
stressing a good diet now--high fat?  Should I work toward "bottle feeding
like a breastfeeding mother"?

What would you do?

Patricia Gima, IBCLC
Milwaukee, Wisconsin, USA


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