A mother was referred to me at discharge for very sore nipples; the
hospital's CLE had not been on duty during mom's stay.  It was one of
those pretty quick and easy fixes--- show her a few tricks, no pain, and
great intake o 1.5 oz!  Baby was 2 weeks early, 6#14 at birth, 6#7 when I
weighed her at our initial visit on day 5.

I also found out at the time that mom had breast reduction surgery 3
years ago, with 1.5lbs of tissue take from *each* breast.  The visible
scar ran under the breast, in the crease, from the armpit area almost to
the middle of the breast bone, being visible only when the breast was
lifted up.  The surgeon had left tissue attached to the areola and nipple
during surgery, which I was pleased to hear. Mom reported that she had
leaked copiously during pregnancy. I was cautiously optimistic for her
after hearing the latter and seeing a good intake for baby in a short
amount of time.

However, she called me back on day 7 to ask if baby needed a pacifier, as
she was coming off the breast after only 5-10 minutes, then waking up
again soon after and sucking her fists and fussing some. Mother had been
feeding "on demand", but that was becoming a potential "all the time".
Diaper output was several moderate wet diapers and one large BM in the
past 24 hrs. I encouraged her to do some breast compression during the
feeds, and also to eat a bowl of oatmeal that night (and every morning
thereafter), as well as try to obtain fenugreek (3 caps TID) and blessed
thistle also, if possible (20 drops sublingual TID).  The next day, baby
was still borderline and I was leaving town, so I recommended that she
rent the baby scale for the weekend to chart baby's intake, and then
supplement if baby feel below the amount I calculated that she needed per
24 hrs.

Mom just returned the scale today, Monday.  She says everything is now
going great!  Mom commented that, after the oatmeal, fenugreek and
blessed thistle, her milk production suddenly "kicked in" on Saturday
(day 9), and she is again oozing milk and baby is tanking up (1.5-2oz per
feed) and sleeping well and stooling more often again, waking about every
2 hrs for a feeding.

She also told me that her health food store didn't have the blessed
thistle tincture but did have capsules, so she bought those instead and
also took 3 TID.  We don't know if it was the oatmeal, the blessed
thistle or the fenugreek, or maybe all 3 that did it, but we feel rather
certain that something here made the difference in her milk supply.
Mother will probably continue to take them indefinitely, but we did
discuss cutting back to 2 TID and then whatever, gradually, to see if she
is able to sustain without, or what level she requires.

At any rate, I have a satisfied mom and babe, and that is encouraging. I
wanted to share the short term will you all; the long term results are
still to come. I hope to keep in touch, and mom will call me if anything
changes.

-Lisa Marasco, BA, IBCLC