Hi Julie
I think that the mom you asked about is having low supply due to infrequent,
ineffective breastfeeding in the early days. I have seen several moms who
lost their once full milk supplies very quickly due to this. I have seen
some moms who do not put baby to breast nor pump and other than that they
have no risk factors, but that is a BIG risk factor, and their milk does not
come in.

I had a mom this week who stated she wanted to breastfeed, but had a
c-section birth, was very sedated the first day, just felt lousy and tired
the second day, and did not want to initiate bf no express. Ultimately she
decided the baby was "doing so well on formula" that she would stick with
that. She has not even held her baby much. I predict she will have very
little problem with engorgement, although her breasts and history appear
perfectly normal and she has usual amounts of colostrum. I think, even if
she didn't breastfeed, but was holding and cuddling her baby alot, she would
get a milk surge. I've seen this happen many times.

I would encourage your client to nurse frequently, consider a supplementer
at breast, consider the finish at the breast method (if she's bottlefeeding)
on the lowmilksupply website, and consider use of galactagogues.

<<She reports feeling like her breasts became very full on Saturday, but
they have not been full since.  Baby was nursing poorly at this time and mom
reports that she wasn't feeding him frequently enough.>  >

Laurie Wheeler RN, MN, IBCLC
Mississippi USA

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