Hello Everyone,

I've been reading the archives but would like to post this situation anyway...

Helping a second time mom with 18 day old baby.
Baby weighed 7 lbs 14 oz at birth born at home- no complications...
Lowest recorded weight was 7 lbs 5 oz on day 3.
Highest recorded weight was 7 lbs 15 oz (mom recalls this as being on day 6).
Today baby weighed 7 lbs 11 oz.

Mom did not notice increase in breast size during either pregnancy but did have darkening of 
areolae. Mom had retained placenta with first baby. She felt that supplementation led to downward 
spiral in supply that she never recovered from, even after placenta was removed. She purchased a 
Pump in Style, she took fenugreek and nettle (among other herbs which she can't recall now) and 
used an SNS in an attempt to save breastfeeding. (She did NOT have a blood transfusion and does 
not feel she lost a lot of blood in association with the retained placenta)

After this birth she experienced slight breast fullness in the early days of breastfeeding, but 
nothing she would describe as dramatic or uncomfortable. She has small but symmetrical breasts. 
I would describe them as completely normal for a slender non-lactating woman. They seem flaccid 
like close-to-weaning or non-lactating breasts. She can squeeze milk from them but never sees 
milk leaking from the other breast when she is nursing. She only hears audible swallowing from 
the baby during night nursings. She sleeps with the baby and cue feeds. The baby is never happy 
off the breast any time during the day, but will sleep an hour or two off the breast after a night 
nursing with copious audible swallowing. 

The baby is very thin but latches beatifully and nurses vigorously at first. The mother's nipples are 
not damaged or sore.

After nursing from both breasts and for about 40 minutes and to sleep the baby had consumed 
just 2/10 of an ounce. The mother reports when she pumps after nursing she can only pump 
enough to cover the bottoms of the collection bottles. The mother describes the stools as watery 
but frequent 6-10 times a day.

She is a vegan, and daughter of a vegetarian- her mother came with her to the consult. They 
impressed me as knowledgable and motivated so I'm inclined to think B-!2 deficiency is not the 
culprit. However she does consume a lot of soy and I wonder about the role phyto-estrogens 
might be playing in her difficulty. I have asked her to replace the soy she consumes with other 
protein sources for the time being.

 Do vegans need to consume a lot more food than non-vegans inorder to absorb all the nutrients 
they need out of their food? (I'm thinking about whether or not fiber or phytates can alter the 
bioavailabiluty of nutrients...) She kept a diet diary in conjunction with her Bradley class and her 
highest recorded protien intake in one day was 90 grams.

The mother's mother has a thyroid with only one functioning lobe. When she was younger this 
presented to no problem for her...she conceived and breastfed her children with no trouble...but 
she has needed thyroid replacement in recent years.

I sent her home with a scale. She is planning to nurse and then supplement on as needed basis 
according to the test weighings...I am hoping night nursings might not require supplementation. 
Whenever a nursing requires supplementation she is going to pump while the baby is digesting 
the formula supplement. Her experience with supplementing at the breast with her first child was 
not a positive one, but I sent her home with an SNS in case she decides she wants to use it.

Any input would be greatly appreciated.

Jennifer O'Quinn
IBCLC

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