Hi Jessica,
Well I don't know how quickly the baby gained, if he is gaining
appropriately now on her supply, what kinds of volumes is she actually
obtaining, what pump etc? When she says some days she gives "4 bottles,"
what volumes is she referring to?

However, I will say that having ineffective milk removal for the first 4 wks
in a primipara, is a very high risk situation for insufficient milk
production. So I am not surprised that she is not up to full production yet.
I think it is normal for a supply to be "all over the place," again I'm not
sure exactly the numbers she is referring to. But it is not unusual, as I'm
sure you know, for a mother to get more milk at some times of days, and even
on different days, a mother's supply is not always static.

As to what you might be missing, not necessarily anything, just the
unfortunate problematic start. You might want to further inquire, although
you probably have already, as to the baby's gestational age at birth, the
specifics of her labor and early postpartum period, the possibility of
tongue-tie or low tone or other contributing baby factor, size and shape of
mother's breasts, breast growth, medical history, medication use (several
moms in my experience were taking antihistamines, for example), hormone use,
pumping frequency, fit of pump flange, can she add massage, hand expression
to the pump routine? Can she use a supply line at breast, if baby is
effectively suckling now? Has she used or considered galactagogues?

Of course I would encourage her to stick with this, her baby deserves it,
especially after his rocky start. I expect he is getting stronger, so we
know a healthy baby who is frequently breastfeeding effectively will do
wonders for a milk supply in most cases.

Laurie Wheeler RN MN IBCLC
Mississippi USA

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