It sounds like the baby did not get off to a vigorous start. I am thinking
due to the C/S birth, there was some mother-baby separation, and delayed
initiation of bf, and possibly infrequent early feedings. 

***** Yes, all of these things seem to be true of this dyad.  


Was mother induced due to blood pressure? I frequently see inductions resulting in babies who are less interested in feeding, at least that is what it seems to me.

***** Mom was induced although she could not give me a reason why.  When I first saw the baby, I felt like his overall tone was somewhat low and he continued to be very sleepy and hard to wake even into the 3rd week, without any jaundice issues.  When I relayed that to the ped the response was, "he's fine."


Is the mother heavy? Seems there is reason to believe that overweight and/or obese women have higher chance of lactation problems, could be due to positioning, latch, or estrogen stuff.

***** Yes, this mother is definitely overweight.


So what to do now? If this were my client I would work as best as I could trying to get an effective latch. Perhaps even a nipple shield would help baby grasp. I suggest galactagogues (I like the Motherlove mixtures, they seem to have pretty good results), we have reglan as a prescription galactagogue that can be used with the herbs.

***** Mom has taken fenugreek and blessed thistle at Dr. Newman's suggested levels (definitely smells like maple syrup) for over 2 weeks.  She added Reglan 5 days ago.  No increase with any galactagogues.  Perhaps my experience is limited, but I would have expected her to be responding by this point if she was going to.


I do *not* recommend a pump in style type pump but feel a rental pump is needed in these situations (Elite, Classic, Symphony, e.g.) because this is *not* a mother who has been bf a vigorous and thriving baby and now has to miss a few feeds a day to return to full time employment after at least 6 wks.

***** Mom was resistant to the idea of a rental pump because she had already forked over the $$$ for the PIS but I agree with your thinking.


I would suggest mom consider a lactation aid to supplement at breast.

***** Mom and I talked about this at the beginning but she was feeling very overwhelmed and didn't think she could do it.  She was getting quite a bit of family pressure to breastfeed and pressure from hubby to not add interventions that would further increase the time it took to complete feeds (so they could get more sleep).  With all of that combined, it wasn't an intervention she was willing to try.  I think I will suggest it to her again since she is 4 weeks PP rather than 1.5 weeks PP.


Thank you for your feedback Laurie!  I found it really helpful.  "Fluffy" breasts with a "loose and stretchy" nipple/areolar complex was a dead-on description of this mother's breasts.  

Sincerely,
Brenda Carroll, MA, IBCLC
Lactation Solutions

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