I usually explain to moms in this sort of situation, who have been neglected, that they may have had some loss of milk-producing cells because of lack of stimulation/breast emptying early on. However, I explain that by working to bring back the milk, they are undergoing the process called relactation. I explain that it has greater success than induced lactation for moms who are adopting. I usually estimate that it may take 6-8 weeks to achieve a good volume. I agree with others that after the 8 weeks, supply often will continue to increase over time. The keys are obvious to us- frequent nursing and optimal breast emptying. If she were my patient, I would keep her on metformin. Given that metformin is derived from goats rue, I don't think I would add goats rue. However, I would add domperidone, fenugreek, and moringa leaf. Make sure she knows how to use her pump correctly if she is not nursing regularly, adding manual expression.
I would definitely give her hope! I have had excellent success doing this. I am amazed at the number of mothers I see who have PCOS and type 2 DM who make oodles of milk. Although the studies are small, less than 50% of moms with PCOS have insufficient milk, so there are other factors, such as insufficient breast development with puberty that play a role.
Anne
Anne Eglash MD, IBCLC, FABM
Clinical Professor, Dept of Family Medicine
University of Wisconsin School of Medicine and Public Health
Medical Director of UW Health Lactation Services
Co- Medical Director, Mothers Milk Bank of the Western Great Lakes
President of The Milk Mob, A Gang of Breastfeeding and Human Lactation Educators
www.themilkmob.org
Breastfeeding is Nature’s Health Plan
-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Debbie Dixon
Sent: Wednesday, July 22, 2015 10:52 PM
Subject: DELAYED / INHIBITED LACTOGENESIS II
Hi
I have a question re a mother who has a newborn 1 week old today. She has PCOS, diabetes (on Metformin tablets - not insulin) and is under the regular care of an endocrinologist. The birth was traumatic including morphine and an epidural. She had very little skin-to-skin time and not much was encouraged in the way of breastfeeding promotion. The mother fully intended to breastfeed.
She had colostrum and was not offered an electric pump in hospital when the milk did not come in normally or other relevant breastfeeding advice.
From the sounds of it, very little encouragement was received from the midwives with breastfeeding. She came home in tears from the hospital 2 days ago, devastated, having been told that she would not be able to breastfeed!!
At 1 week old, she now has mature milk but very small quantities. She has extremely high stress levels and now can't bear to put baby to breast but wants to breastfeed (I haven't worked out yet how strong that desire is at this stage due to what has happened). She had a visit today from the visiting midwife who did not even ask her to put baby to breast while she was there!! She did not suggest a hospital grade pump or any "real" help!!
Mother is currently only using a hand held pump (and no one from the hospital has made any comment on that)!!
I am flabbergasted!! I suspect this mother may not achieve a full supply, but the hospital staff appear to be not encouraging what capability there is!!
At this stage (1 week), is it still reasonable to expect a full / better supply that what there is with good lactation advice and double pumping with a hospital grade pump, to see what the breasts are actually capable of? At what point does involution occur especially for someone with this sort of endocrine history? (Was trying to find these answers in my books but couldn't find anything specific, so thought to post here).
Many thanks for any suggestions anyone can give.
Debra Dixon
IBCLC
Australia
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Date: Thu, 23 Jul 2015 11:54:09 -0400
From: Mary Coutts <[log in to unmask]>
Subject: NICU pump loaner program
Going back to discussion this past March: News posted 7/20/15 regarding military pump coverage:
http://www.militaryfamily.org/featured-news/tricares-breastfeeding.html
Concerning news is: "TRICARE will cover lactation counseling only when it is provided by TRICARE authorized doctors, physicians assistants, nurse practitioners, nurse midwives, or registered nurses. We fear access to effective lactation counseling may be hampered since TRICARE is NOT covering other types of lactation counselors such as Independent Board Certified Lactation Consultants (IBCLCs) or Certified Lactation Counselors (CLCs.)"
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Date: Thu, 23 Jul 2015 20:13:55 -0500
From: Laurie Wheeler <[log in to unmask]>
Subject: inverted nipples
Hi Jackie,
Glad you posted. You are right babies are supposed to be able to latch to the breast, but doesn't it seem so much easier with a perky breast and everted nipple? I can't explain it, but it seems the nipple is necessary to extend to the back of the tongue. It seems without that, the baby just can't grasp and control the milking of the breast.
In your case example, I would certainly try a nipple shield but first putting baby in breastfeeding positions to bottle feed as he is used to.
Eventually seeing if he would make the switch to latching to the shield. In the meantime, I've heard of some moms having success with supple cups see link below (no financial interest).
http://supplecups.com/faqs.html
Laurie Wheeler RN MN IBCLC
Mississippi Gulf Coast USA
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Date: Thu, 23 Jul 2015 20:21:04 -0500
From: Laurie Wheeler <[log in to unmask]>
Subject: delayed inhibited L II
Hi Debbie,
There is no way of knowing what mom's milk supply will be, however, there is certainly a good chance to increase the production that is already there. I would definitely explore what mom wants to do or feels able to do.
She may be telling you one thing while the midwives or others have actually offered help. Unless you were there to see the interaction, remember there may be another side to the story.
However, take mom at face value, and meet her where she is. I would suggest lots of skin to skin which will help in so many ways, as you know. Then let mother know that expressing is the key to increasing production and offer the the options of hand expression, manual, or electric pumping. That's all I would do at this time, and take it from there.
Laurie Wheeler RN MN IBCLC
Mississippi Gulf Coast USA
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End of LACTNET Digest - 22 Jul 2015 to 23 Jul 2015 (#2015-275)
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