Riva writes:

What is  interesting, in light of the discussion on pumping, she discovered 
that she  has a very delayed let down. When she pumps she has to continue 
stimulation  for over half and hour in order to get 80 cc.
 
~~~ I worked with a mom with a severely delayed letdown like this. It  
kicked in later, was not something I saw when working with mom in the early days 
 ( I always watch the mom pump at least once so I would have seen it). In 
fact  she never actually told me she did not let down for 30 minutes until 
months  later ( and I never knew to ask.) She made plenty of milk, it just 
took forever  to get it to release.  I'm not sure if she was ever diagnosed by 
a  doctor, but at some point she told me she thought she had  
hyperthyroidism ( figuring it out after talking to another mom, I  think.)  Looking back I 
wonder if she had a form of Postpartum Thyroiditis. Her baby was  
completely breastmilk fed on this pumped milk for about a year I think (  with 
complementary foods in place then).  Baby never did latch on and  breastfeed no 
matter what we tried. I think he had his own issues which she was  not 
supported in addressing so this just made everything more  complicated.  She was 
able to keep up her supply expressing milk only 3  times a day for months. I 
wonder if this mom you are talking about Riva has a  thyroid issue going on.
 
As for why a baby with reflux would take a pacifier and not an "empty  
breast", I wonder if baby simply developed a negative ( painful,  
scary/breath-compromising) association with refluxing interrupting the previous  good 
experience of breastfeeding, and is now feeding only long enough to move  away 
from being overly hungry but then stopping rather than keep going til  
satiation as before... Many babies are helped with CST when they have reflux  
issues. Some moms offer a few sips of expressed milk from a little spoon or cup  
to deliver the pain-killing aspects of mom's milk, soothe the burn, and 
either  then baby will breastfeed a little more, or at least get a little extra 
at the  end of a feeding ( quick hand expression after baby stops.) 
 
Just some thoughts,
Peace,
Judy
 
 
Judy LeVan  Fram, PT, IBCLC, LLLL
Brooklyn, NY,  USA
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