Hi Barb. Weekends can indeed be quieter here, ...let's see what thoughts
come to mind.


>Would appreciate your input on increasing milk supply for a mom with a 7
>dayold infant who had lumpectomy for breast cancer in 2000 with radiation and
>chemo.  The treated breast, R., is not producing and did not undergo changes
>as her L did during pregnancy.

I  have a neighbor who is a radiation oncologist. The radiation used,
according to my physician neighbor, is like Niagara Falls in terms of
strength,..whereas the radiation used during dental exams etc is like a
drip. It can  destroy milk making tissue.

>Initial supply on functioning breast produced
>infant wt gain WNL but then faltered with infant wt loss so currently
>supplementing at breast with EBM and ABM as what she can pump is
>inadequate-20-30 cc an hr after breastfeed.


How often is she breastfeeding on that side?  Technically, she should be
able to produce enough milk on that one breast, as twin mothers do.
Frequent and efficient suck needs to happen often...with subsequent milk
flow and emptying.

>  I have her using a Medela
>Lactina but only puming on L, single pumping.  She's only been doing this for
>past day and a half so perhaps there just hasn't been enough time to
>ascertain possibility of increase but I don't want to let too much time go by
>if there is something that can be done to more rapidly increase.

Why not have her breastfeed on that side using a lactation aid if necessary
to augment flow and intake? That would do much better for her supply, with
the skin to skin  etc, than any pump.


>Baby was jaundiced peaked at 16 or 18, can't remember exactly but since
>intake increased with supplementing, bili going down.


Fixing the latch so that it is as effective as possible, and augmenting at
breast with a lactation aid such as a simple 36" #5 feeding tube would
really help here. An SNS or Lactaid also could be used. I would use the
technique described by Jack Newman MD at www.breastfeedingonline.com, Cindy
Curtis' page.

>  This seemed to effect
>his sucking as he's somewhat better, more efficient at beast, and definitely
>more alert.  He was small at birth, 63, 4 oz at 40 wk gestation and a slow
>feeder needing lots of stim/breast compression to keep BF with milk transfer;
>he fed fine with supplement at breast, tho, good rhythmic swallowing,
>coordinated.  This is what makes me feel if supply can be brought up he'll do
>fine; some fine tuning over time will probably be needed, I realize.


Great that you are using breast compression, frequent effective emptying,
and a lactation aid at breast.


>So, is there something in regard to pumping that could yield more milk?
>She's on More Milk Plus, we've discussed Goat's Rue and Domperidone, as well,
>and come tomorrow will see if one of these indicated.  I suggested moist heat
>while pumping and this am suggested stimulation of L nipple as well as R
>(functioning) prior to pumping to elicit MER.  I have her pumping for about 5
>min immediately post feed to "empty" breast and then a more thorough pumping
>of 10-15 min an hour later per Hartman's newer info re milk synthesis.


Domperidone would be a good choice here.

>   Would
>double pumping provide more stimulation thus increase in output even tho R
>breast non functioning?  This thought nags me as I've seen moms who single
>pump increase dramatically with double pumping.  Mom did say she had
>sensation in R nipple/areola and so my suggestion to stimulate both nipples
>prior to pumping.


It cannot hurt.


>Baby, by the way, on Fri eve able to get 34 cc after an hour of intermittent
>breastfeeding with much breast compression and stimulation/relatching to keep
>feeding.
>
>Sorry so long but thanks for any suggestions-just don't want to miss
>something she could be doing.  The other factor we've discussed is that since
>her baby's birth he's had to be seen by pedi for wt and bili checks daily so
>ppoor little guy and mom have been under a bit of stress, to say the least.
>Skin to skin is always in use.


I'd put her and the baby to bed with some funny movies, some good food, and
continuing lactation support, and see what happens. Frequent weight checks,
keeping track of I and O, and Domperidone would also be good to do now.

Kathleen

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