I just saw my client from 6 days ago with low milk production.  She has 
been pumping 8x/day with a Symphony pump, standard flanges, and now is 
getting 6 oz in 24 hours (up from 3 oz a week ago).  Baby is getting 
that 6 oz plus 4-6 oz of formula by bottle, and breastfeeding.  Weight 
gain was excellent, 7 oz in 6 days.

Baby only transferred 0.4 oz from each breast for a total of 0.8 oz.  
Mom had not pumped and baby had not eaten in about 2.5 hours before the 
consult.  When she pumped after this, she got  ---.  Baby took an 
additional 1.5 oz from the started SNS and then 1 oz from an Avent 
newborn bottle using paced feeding.

Mom does not want to take prescription galactogogues.  She is now going 
to try a starter SNS for a while and consider getting a Lact-aid if she 
likes that system.  She (and I) are feeling very discouraged about the 
lack of improvement in her milk production, and she is afraid to stop 
pumping for fear that the baby won't maintain the milk supply that she 
has.

She is in the process of getting her hormones tested, and will be 
getting a breast ultrasound to check out some lumps, so I will advise 
that she ask if the glandular tissue is there in normal amounts.

Thanks to all who responded with ideas.

Lynnette Hafken, MA, LLLL, IBCLC

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