A difficult case.   She sounds like a motivated mother, working hard to exclusively breastfeeding, and you acknowledge that effort.  Agree with her that she is right to be cautious about formula, but in this snapshot of one feeding, the baby didn't take an ample meal, and her pumping isn't yet able to provide the extra that this baby needs.  Parents don't always know how quickly a baby's intake needs to increase in the intense early weeks.  There are a lot of variables in her situation -- an early term baby, a c-section recovery, her own health challenges.  The first rule is to feed the baby, because that stabilizes the situation and buys time to sort out the variables and see what can be done to build the supply.  In lieu of a steady supply of donor milk, she's using formula as it's meant to be used-- as a substitute nutrition to feed the baby and keep the baby happy, gaining and energetic enough to feed well and help push the supply.  A baby that's not gaining well is not a very good dance partner!

She needs to see a way forward -- that the formula isn't the end of the road.  The supplements are a tool in her efforts -- feeding the baby buys time.   She can be reassured that the baby is getting plenty to eat, and she can use the energetic baby (still only 38 weeks gestation) and the pump as "twins" to push the supply, and see if she can chip the supporting formula back out of the situation. If the baby and the mother love the feeding, this is a great case for at-breast supplementation for at least some of the feedings.

 And to introduce the idea that breastfeeding doesn't have to be all or nothing -- in a world where some babies never get a drop of mother's milk or a minute enjoying the cozy act of breastfeeding, her baby is already ahead of the game.  We can't control everything that our bodies do.  She can do what she can to improve her Addison's, but she can't make her adrenal glands improve their function by "working harder."  The breast is another gland in her body, and milk-making is a complex process.  

And to make sure that she has a lot of resources for her mental state during this unexpectedly difficult start to breastfeeding.  Help her feel that she is on some common ground -- all new parents are dealing with strong emotions, and she's having added challenges.

Good luck to all.

Margaret Wills, IBCLC Maryland USA


> 
> Date:    Sun, 11 Aug 2019 04:43:11 +0000
> From:    Lisa King <[log in to unmask]>
> Subject: Effect of Addison’s on Lactation
> 
> I need information for a new mom who lives with  Addison’s Disease. She also has PCOS. Her endo told her during pregnancy that he saw no reason why she should have any difficulty with lactation. She had breast changes in pregnancy, baby is now 2 weeks old, born via c-section at 36 weeks due to low amniotic fluid. Latches well, sleepy at breast, clearly still hungry after bf. Late afternoon test wt transfer was 18g total after feeding for about 20 min on each side, after which she pumped for 10 min and got less than an ounce total. Will have a wet check again on Monday to discuss next steps. Mom loves bf and is resistant to supplementation with formula. Also has Hx of mood disorders and is showing signs of ppd. Wants to bf exclusively and is working very hard. I feel that her endo did her a disservice by not letting her know at the very least that she might need extra support or might not make all the milk her baby needs. I am having trouble finding current info on lactation and Addison’s Disease, which I feel is central to what’s happening here. 
> Thank you!Lisa King, MPH, IBCLC 
> Sent from Yahoo Mail for iPhone
> 
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