Dear Lactnetters,

A mother I worked with in the hospital has given me premission to post
for more ideas.  I am posting frm home and do not have the chart
(obviously) so forgive me if I miss details you would like to know.  I
can reference them at your request.

Mother had a breast reduction at the age of 18 years.  She states she
has moderate nipple sensation.

She had her first baby two years ago and worked extensively with LCs to
create a good milk supply (states she actually threw some away because
it was past its freezer prime storage time.)  It required devoted
pumping and use of the SNS.  Mother reports baby would always be willing
to suckle but was passive sucking unless on with the SNS.  First baby
began nursing well in hospital but developed jaundice and was
rehospitalized, put under lights, etc. and supplements began because
of low output and very sleepy baby.  Mother only felt a milk release in
response to pump, not to baby, and would sometimes turn on the pump to
trigger milk release.  This also caused her heartache as she said "I let
down to the pump but not my baby."

Mother now has second baby, whom she feels is much more aggressive a
nurser.  Mother began SNS due to low output and a dry appearing mouth.
Mother was tearful at the thought of having to do the SNS and pumping
again.  Doesn't see how she could manage with a two year old.  Admitted
to hating the SNS and being so glad to throw it away.

My thoughts are that a) there may be some nerve damage that kept the
messages of sucking to get to the brain for stimulating a milk release,
b) the pump stimulated a supply through pure suction at first and then a
Pavlovian-type response to the sound after a while allowed for a milk
release, and c) baby#1 was a passive baby by nature, as per mother and
father, and jaundice aggrevated the problem so that baby never did pick
up on her role to stimulate and initiate.

My suggestions to the mother were to try to set up a pattern of
behavioral modification that could help trigger the milk release as the
pump sound had.  Ideas shared were relaxing music, sitting in the same
chair, having tactile steps to lead up to latch, i.e., warm compresses,
massage, Marmet technique for expression, Lamaze-type breathing, etc.
We also discussed ways to see to toddler's needs to attain the most
relaxed atmosphere for feeding.

Two questions for you all - Does my hypothesis that it is probably a
nerve pathway intereference make sense?  What else might you suggest for
me to share with her?

Thank you for whatever ideas you can give me to share with her on Monday
when I am due to follow-up with her.

Cindy Garrison, BS IBCLC
Pittsburgh, PA, hospital based

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