Hello,

I have had a number of moms I've seen lately with difficulty sustaining an 
adequate milk supply. A couple of these cases have been moms with twins. 
The usual scenario: mom has her babies, is supplementing (with SNS or bottle) 
in the hospital due to prematurity and/or weak suck, and goes home pumping 
after each feeding attempt to faciliate emptying of breasts. 

The moms I have worked with are motivated, and I have no reason to believe 
they are not pumping as frequently as instructed. I have had really difficult 
problems with these moms becoming frustrated at lack of milk production and 
becoming sick and tired of pumping for days and weeks on end. A common 
question is "when can I stop doing all of this pumping"? It also doesn't help 
that baby slurps the bottle down, and will not nurse for more than 3 minutes 
before falling asleep, even at 3 or 4 weeks of age. 

Moms who use the SNS find that baby begins to nurse less effectively over 
time, slurping on the tube or flat out refusing to nurse without the device in 
place.

I am wondering what other LCs do in situations such as this? We try herbs, 
tinctures, domperidone, reglan. Nothing seems to help. It seems that once a 
mom goes home with a non-nursing baby, the hormonal response to the pump 
is just not the same. 

I would really like feedback on how to more effectively counsel the mom in this 
situation - do I tell her to pump less frequently, and possibly risk her supply 
from decreasing even more?  

Thank you!
Brenda Phipps, BS, IBCLC (for 13 years, and still learning!)

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