Dear Lacnetters
I have been helping a mother here in Tokyo Japan, who is exclusively nursing
a  6 month old baby, and  who is now 11 weeks pregnant. She feels that her
milk supply is dropping, baby is very fussy at the breast , swaps from side
to side constantly, nurses very often during the day and then nurses more
intensively at night, always with the same fussing and changing  and is now
having greenish stools.

Previous history is that from early on postpartum she ironically had
significant issues of OAMER and oversupply. Some fine tuning of the nursing
pattern to six hours on one side before giving the other helped baby to
nurse more comfortably and be more settled after feeds, stools which had
been green and gassy changed to yellow and then mother also found her
oversupply issues settled down too. Baby has always nursed day and night,
never any supps, no pacifier, co sleeps with mother. Mother  must be in the
2% for whom LAM method is an unsuccessful form of contraception, as she fell
pregnant again very quickly without resumption of her periods. Babies will
be 13 months apart. (On a separate note, I am wondering if there is any
evidence that solving OAMER and oversupply issues could also be directly
related to an early return to fertility? Has anything been published on
this? What about in other Lactnetter's experience?)

Mother is currently taking pregnancy vitamins with iron, which we discussed
might be contributing to the fussiness as per the Breastfeeding Answer Book,
though with the demands on her body of 2 very close pregnancies she feels
she would like to take some sort of vitamin supplement. Pregnancy vitamins
per se are not sold here in Japan, most people have them flown in from
abroad.

I have a couple of questions. If she begins a regime of milk expression
combined with nursing, bearing in mind her pregnancy, is this alone likely
to help her supply increase? What else could she safely do to increase her
milk? She is aware that the hormones of pregnancy can cause a reduction in
supply, but was thinking that she was still too early in her pregnancy for
that to have started happening.  She is now very concerned that her baby is
not able to get enough nutrition, and while starting solids is of course an
option, she wants to avoid her milk supply diminishing any further at this
point if at all possible.

I would appreciate the benefit of your collective wisdom.

Thankyou
Iona Macnab
LLLL and IBCLC (2002)
Tokyo Japan.

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