I need the assistance of the group wisdom. I have been a reader of LACNET for years, but haven't posted in about 10 years. I have a patient that I am working with, that is having problems with her milk initiation. I have her permission to post this email. She is 34 YO, professionally a nurse anesthetist. G3 P3, She delivered natural triplets on 12/15. She was started pumping within 12 hours of delivery (I know this is late, but for this hospital is very good), and since has pumped an average of 8 times daily with the preemie programmed symphony. Her Triplets were 34 weeks gestation and a good size at 2.0, 2.4 and 1.92 K. Her previous deliveries were in 2009, and 2007. With both previous children she had a solid milk supply which came in quickly. She breastfed the first for 8 mos, and pumped for an additional 4 mos with enough surplus milk to last over 2 additional months. With the second baby she nursed for 14 mos. At day 5 yesterday, she is still only pumping drops to the largest volume of 10 mL.
Her pregnancy was significant for anemia and she received several iron infusions, at delivery her hemoglobin was 9.8. Her breasts are soft, with no indication of filling. She has some dependent edema, most notable in her ankles, but nothing really outrageous. I am stumped? Why isn't she getting her milk in? Please let me know what you think, or what to do.
Denise Breheny, RNC-MNN, IBCLC
Charlotte, NC
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