I am working with a client right now who has low milk production, and I
could really use some feedback on how I am managing this case, and if
anyone out there has more ideas.
Mom is a 31-year-old G1P1 who gave birth at a birth center with no
medications. Baby was 38.5 weeks gestation. Birth weight was 5 lb 10
oz and at 2 weeks was 5 lb 6 oz. Stooling was infrequent. Mom
initiated formula supplementation after every breastfeeding on the
pediatrician's advice, and initiated pumping with a PISA 4x/day. She
never experienced engorgement and felt that her milk came in on Day 5.
Breastfeeding was painful initially, and some bruises were present on
the areola. The nurse practitioner helped her with her positioning and
latch, and the comfort improved. After baby started gaining well and
stooling once/day, they pared the supplement down to 6 oz a day and
reduced pumping to once or twice a day.
When I saw this mom, the baby was 3.5 weeks old and weighed 6 lb 9 oz.
She was very sleepy at breast, with a suck-swallow ratio of 1:5 or so.
Breast compression helped increase the swallowing, but it was never
1:1, and test weights showed an intake of 0.5 oz per breast after about
15 minutes on each breast.
I recommended that the mother give a supplement of 1.25 oz before each
breastfeeding, then breastfeed to satiety, per Tina Smillie's method.
I stressed the value of breast compressions and listening for
swallowing. (She was having the baby at breast for hours with probably
not much milk transfer going on.) I also recommended that she pump at
least 8 times a day with a Symphony pump. The flanges appeared to fit
well, and we got a full ounce out of the right breast, after the baby
had taken 0.5 oz. The latch seemed adequate, but we worked on
improving it.
Mom has no history of thyroid issues, fertility issues, PCOS, breast
surgery/injury. She is planning to get her thryoid, prolactin,
estrogen, progesterone, and iron tested. She is a little hirsute, with
hair all around her nipples. She is normal weight and eats a normal
diet. She does not want to consider prescription galactogogues. She
is taking 6 caps of fenugreek per day, and more milk plus tincture 3-4
times/day. I gave her information about goat's rue.
She is now pumping 5 oz total in 24 hours, supplementing with 6 oz of
formula, and breastfeeding using compressions and massage.
After trying supplementing first for a few days, she felt that the baby
was even sleepier at breast, so we are now going back to supplementing
after every other feeding. She will try a starter SNS at my next visit
and consider using a Lact-aid if she likes the sns.
This mom really wants to breastfeed exclusively. Can anyone offer any
words of wisdom? I would love to hear about cases similar to this that
have worked out.
Thanks!
Lynnette Hafken, MA, LLLL, IBCLC
***********************************************
To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html
|
