Hello to all of you marvelously helpful people~~
This is my first posting and I hope that someone can help me and a
colleague figure this one out.

Today a 21 year old mom came in to see us. She has a 3 year old son who she
breastfed "not for long, but without problems". She now has a 2 1/2 month
old daughter who seems to only "snack" at the breast. The mom reports that
the baby has never slept more than two hours. The nursings are brief--5 to
12 minutes on average. After nursing on one side, the baby refuses the
second breast--screaming and fighting. An hour or so later she will nurse
quite contentedly from that side--but again, only briefly. An hour later
the whole scenario repeats itself. At night, the intervals are even closer.
She says that the minimum number of times that she has nursed is 13 times
in 24 hours.

The mother is amazingly cheerful, though exhausted. Her husband seems
supportive and helpful. The baby is healthy and gaining weight
appropriately. She was born at term ( 39 weeks) and weighed 3345 gms. The
mom reports only one stool a week--copius amounts the consistancy of peanut
butter and 6-8 wet diapers a day.She has not been supplemented with formula.

Today, at our visit, the baby nursed about 10 minutes on one side--obtained
1.6 oz and refused the second breast. An hour or so later, she eagerly
nursed on the second breast and got about another ounce. Maybe not an over
abundant supply? The mom says that she can feel "one letdown" and then
feels as if the breast is empty. She has tried pumping with a Lactina to
increase supply and usually gets 1/2 to 1 ounce in 15 minutes. She has
tried a "nursing honeymoon" to increase supply. Switch nursing is futile
since the baby screams and refuses when she tries to switch. When she has
been able to accumulate some pumped milk, the baby has eagerly taken 4 oz.
from a bottle and seemed to want more.

The baby had been gassy and fussy and seemingly "in pain". The mom removed
all dairy products which has helped in that respect, but the "snacking"
type feeding persists. She does not take any medications other than her
prenatal vitamins, "but not faithfully".

The pregnancy was complicated with kidney stones. The mother was induced at
39 weeks because of her severe pain, and actually had an epidural for THREE
days. She had a vaginal delivery with some increased blood loss--but not
hemmorhage. We get our babies nursing within an hour of birth. After
delivery the kidney stone was removed, and she went home in good
condition.Her postpartum check-up was normal.

The baby was nursing well on discharge from the hospital, and she met with
us a couple of times after that because of questions and sore nipples. Her
milk supply seemed adequate at the time, and the baby was gaining weight.

The mom has never had breast surgery. She does have a history of ovarian
cysts, and will have her thyroid levels checked on Monday. She is very
willing to try anything--we suggested fenugreek as a start. She will come
back to see us in a week.

I wonder if this is a mom with a "low" supply? But then why won't the baby
take the second side right away?

Any ideas or advice will be greatly appreciated!

Kirsten Husband RN IBCLC
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