Celina, as I read through your post, it is clear that you have collected a significant amount of information from this mother.  Yet a couple of critical pieces of information are missing: how many times does she remove milk during her work day (and how long is her work day) and how does this mother define "increased nursing through the night"?  In total, how many times does this (5 month old?) baby breastfeed each day and how many times does she remove milk (either breastfeeding or pumping)?



If the mom is working full time and also has an 8-yr old at home (who possibly needs rides to/from various places), it is likely that her breastfeeding experience is much different with this baby compared to what she experienced with the older child.  She may have less energy to sustain night feedings, depending on her work schedule.  Where is the baby sleeping?  Does she get up to go to the baby at night or is the baby near her?



It sounds like the mother was given poor advice (teach the baby what it's like to be full by not feeding the baby) before she saw you and that advice could have suppressed her milk supply as well.  It may be that her milk storage capacity was on the low side, but the baby was able to get by with frequent feedings.  



Also, what is going on with the baby's weight?  It would be helpful to know if the baby's weight is stable now or if growth has slowed beyond what is normal for a baby this age (the age at which we often see a plateau in weight gain).



I would explore all of the possibilities related to the need for frequent milk removal to increase/sustain milk supply before looking for reasons for low supply related to what happened during the birth.  Also, I would remind her that all of the galactagogues in the world will not work (or will not be very effective) unless she removes milk frequently throughout the day.  Sometimes mothers don't even realize how infrequently they are removing milk.  It is helpful to walk them through their day to get a clear picture of how many times they are pumping and breastfeeding in a 24-hour period.  Having the baby sleep near her may be a way to make the night feedings more manageable.  Remind her that the night feedings can be considered as a therapy to increase her milk supply, likely to have better results than fenugreek or other galactagogues.



As for the possibility of Sheehan Syndrome, it's my understanding that this syndrome is caused by severe bleeding during the birth and that low blood pressure would be a symptom of the syndrome, not a cause.





Sara Dodder Furr, MA, LLLL, IBCLC

Quality Improvement Specialist

Office of Research, Policy & Quality Improvement

Health Licensure & Investigations Unit, DHHS Division of Public Health 

P.O. Box 95206

Lincoln NE 68509-5026

Phone:  (402) 471-4973 FAX:  (402) 471-0383

[log in to unmask] 

Website: http://www.dhhs.ne.gov/crl/crlindex.htm 





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Date:    Tue, 4 Oct 2011 12:47:11 -0400

From:    Celina Dykstra <[log in to unmask]>

Subject: mom with persisting low milk supply after low b/p ppm



Permission to Post. I have been in contact with a mom who I originally connected with in early September. Her baby was almost 4 months and had been nursing almost every hour. She was told baby had trained himself to be a "sipper" and had received advice to space feedings to no more often than every 2 1/2 to 3 hrs. and to feed baby on both breasts then use sns so he could learn what if felt like to be really full. (he transferred 2oz at the feeding according to test weighing



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