Katherine said: "Many moms have this wonderfully abundant oversupply at the
beginning that can mask/overcome a variety of less than perfect issues
(infrequent feeds, high palates, tongue ties etc) but over time as supply
down-regulates, problems crop up.  They assume the supply is decreasing
which to them is a natural segue into weaning."

This is one of the reasons that our Public Health Nurses have learned not to
close a case too quickly!  Even when breastfeeding problems from early on,
such as sore nipples and engorgement are addressed, the PHNs are keeping
cases open (often beyond when they're SUPPOSED to close the case), to get
follow-up opportunities into the 2 - 4 week period.  It is then that low
milk supply crops its ugly head for many reasons:
 - Moms think they don't need to feed as often
 - Lots of family members handling babies delay feedings
 - All the help leaves and mom is left with baby and toddlers and house (why
can't we adopt the "Cuarentena" (40 days) of some Hispanic cultures???)
 
Mostly the lower milk supply is the result of a "borderline-effective milk
removal skill" by baby that is now down-regulating mother's milk
production...  The low weight gain or even weight loss is not easily
recognized by a mom and family members that live with the baby - and the
Peds appointment is usually at 2 months!

...and yes, I DO believe a referring for tongue tie evaluation even if
breastfeeding is going well - after hearing Dr. Palmer's issues related to
oral development and problems with dentition in later life.

Jeanette Panchula, BSW, RN, PHN, IBCLC
California, USA

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