Coach Smith back again - responding to Karen Foard who asked "what do you do
when milk isn't coming in?"

First, follow Rule # 1 - FEED THE BABY. Everything else is in second place.
What and how you feed the baby is secondary to THAT the baby is fed. Use
mom's milk first, other human milk next if you can get it, and lastly a
manufactured product if human milk isn't available. I'm NOT getting into a
discussion of various feeding devices here, except to advise using the gadget
with the least possible negative effect on breastfeeding. The main point -
FEED THE BABY - supercedes all other discussions of "with what" and "how."

Meanwhile, get mom pumping or expressing and investigate WHY the milk isn't
in.  If it's simply lack of removal of milk, pumping will solve the immediate
problem until the baby can become the "milk removal device."  Since I see so
many babies with lousy suck responses, I no longer rely totally on the baby
for milk removal until I'm SURE the baby can do his/her part. Close, and I
mean CLOSE follow-up is mandatory.

The biggest red flags for a truly compromised milk supply are, not in order:
postpartum hemorrhage causing necrosis of the pituitary gland (Sheehan's
syndrome), retained placental fragments, hormonal birth control especially
estrogens, breast surgery (some milk may come in anyway - but supply isn't
maintained), or insufficient glanduar tissue (rare). Rule these out next.

If the reason for "no milk" isn't on the above "red flag" list, supply should
rapidly increase with consistent pumping or expressing.  If the pump can get
milk out but the baby can't, then this is a baby problem that needs to be
addressed while supply is maintained another way.

Linda Smith, LC in private practice
Dayton, OH