>First of all, all my apologies: mom is 3.5 months postpartum; It may 
>change the situation and explains "how long ago" she stopped 
>finishing her breasts; 1,000 Excuses !


Thanks, Francoise - yes, there is a difference between 2.5 and 3.5 
mths postnatal - this means she stopped pumping/expressing 6 weeks 
ago, and not 2 weeks agi :)

>
>In fact, at the very beginning, she was very weak, due mainly to a 
>considerable blood loss - at least: at one point that she had blood 
>transfusion. She had told me (Day2/day3) she could hardly even go to 
>the toilets.
>Babies had 1st feed back in the bedroom; but because of her weakness 
>she extracted her colostrum for the babies during the next first 
>hours. Then she gave breast till she was very weak ;  she had blood 
>transfusion;
>
>Day 3, breasts soft. At the same time, diapers show transfer is not 
>very good (in number and look) ;
>So I propose she breastfeeds then supplements with her own milk.


Sorry - I *still* don't understand why at 3 days she started to 
express after *every* feed, in addition to breastfeeding. Her milk 
had not come in - of course the breasts would still be soft. Her 
baby's output would reflect that, and stools would still be 
transitional stools. The baby may well have benefitted from 
additional breastmilk to supplement direct breastfeeding, but this 
would be *hard* *work* for the mother (already in a weak condition) 
to maintain - every feed?? Easier for a sick/exhaiusted mother just 
to increase the frequency of the baby at the breast...or am I missing 
something?


>
>Lactogenesis II appeared at day 5/6;
>Massage + reverse pressure softening (seen and shown in prenatal 
>consultation).
>Stools then appear copious and green; gas ;
>I propose she empties her breast before giving breast; she won't 
>freeze, she will give the "foremilk" to her elder child.


Sorry.. this sounds like hard work for her to do. The mother was just 
5-6 days postnatal....things could have settled down by themselves, 
without the intervention.

>The quantity to empty before feeding will be adjusted by her after a 
>"minus 1 oz" from the beginning (the qty to be found will depend on 
>the turn of the color of the stools)


Not sure I  understand this - depending on the colour of the stools, 
she would express less or more? So she would be looking at the colour 
and then judging how much milk to remove? It sounds like hard work 
and the breasts don't really function in that way, do they? Could the 
baby not be 'allowed' to engineer foremilk/hindmilk?

>Her breasts being incomfortable after the feeds, I suggest she 
>finishes until comfort;
>
>By this moment, I know lactogenesis II was late, she had had a great 
>loss of blood (counterbalanced afterwards by blood transfusion) and 
>transfer not so good (lack of stamina); I feel she is going to be 
>overproducing, she has to empty the breasts before the feeds because 
>babies are full before getting the fat.


I am not sure - 5-6 days postnatal is very, very early to be sure of 
over-supply. I would not think of this until about 3 weeks postnatal, 
because every day can be different in those early weeks. Something 
that is a huge problem on, say, day 13 can be resolved by day 15 
without the mother doing anything at all except responding to her 
baby's needs to feed  :)

>but I feel it is too early to do anything. Her production is far 
>from calibration time.
>Emptying after the feeds is supposed to make her comfortable and 
>make eventually some milk if supplementation was necessary.


Yes.....but the repeated 'emptying' makes her make *more* milk and 
makes her *more* uncomfortable and takes up *more* time.....

>I guess she pumped after the feeds for comfort + for the elder 
>child. So it may have not helped.


I agree - may not have helped.





>
>The bad latch of the first days==> corrected quite quickly with 
>semi-reclined position - Nurture Breastfeeding (before: pinched 
>nipple);

Ah - I see, biological nurturing position....yes, can be v. helpful.

>
>By 3 weeks, she leaks easily; she ejects forcefully and far away 
>too; we decide to do nothing special in order to diminish her 
>production because I think it is too early.
>She stops finishing her breasts gradually.


I don't understand that, sorry.

>But nothing else.
>She just continues emptying "a little" her breasts before the feeds;
>Children continue with gas and burps.


Are we talking about twins here?

>They go to breast, feed feed feed, then she stops the feed for 
>burping, then they start their behavior "I wish breast I don't want 
>it".


So we have twins aged 3.5 mths....could this difficult-to-interpret 
behaviour be the very *normal* age-appropriate behaviour of appearing 
to want more breast but not actually wanting it, and wanting 
sleep/play/interaction instead? The mother continues to try to latch 
the baby on, and the baby objects and fights.....and there is a real 
struggle, which the mother thinks means the baby is hungry....and she 
tries again, and the baby feeds for about 10 seconds and then comes 
off, crying and fighting, because that is not what he needs at 
present?  Arching the back is very common - it's part of the 'fight'.


It's hard to say what's going on, and I do think it sounds as if 
breastfeeding was very *complicated' from the start....but on the 
information here there is a real strong chance  that NOW these babies 
are absolutely fine, and are behaving *normally*, and there is 
nothing wrong or unusual in the mother's milk supply or her MER.

:)

Heather Welford Neil
NCT bfc, tutor, UK
-- 

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