Merilee
Yes, many times I run across moms not really following or complying with the
"building up the milk" care plan or any other care plan, for that matter.
First, remember, it is only your job to give advice and follow-up. If she is
not follwoing the plan, and asks why her milk is not increasing, you surely
can say that she could expect more results if she pumped more often, or
whatever. The way I approach it is with some counseling techniques first,
like acknowledging how discouraging it can be to have low milk, how hard it
is to adjust to the new baby, do w/o sleep, etc. Sort of commisserate with
her and acknowldege that it is not easy.

I do not back off from the original recommendations, however, and say
something like "the ideal situation for increasing your supply is to pump
after every feeding, at least every 3 hrs around the clock, and do blah,
blah, blah. But your reality may be different than this, you may not always
be able to accomplish this, so do the best you can."

Also, be sure when you develop the care plan you do so WITH the mother;
mother setting the goals (Linda Smith has a rule that says something like
"it's her baby and the mother is always right."), so that you can give her
the ideal interventions but then ask her "what out of these do you think you
could manage?" or "which of these would you like to try?" Remember, her goal
may be to INCREASE her supply but not to EXCLUSIVELY BF, as I came across
several times last week. We can't assume these things.

Now, for the breasts that are allegedly completely blocked and contributing
to low supply - is this engorgement from week 1 or later? I am not
comfortable w/ the massage if it is very painful. I would go with the basics
of supply and demand and increasing the milk interventions - drain the
breasts well and often to make more milk.

P.S. When I read your posts in the past, I figured you were in Switzerland,
but what does the abbreviation CH stand for?

Laurie Wheeler, RN, MN, IBCLC
Violet Louisiana, s.e. USA

______________________________________________________
Get Your Private, Free Email at http://www.hotmail.com

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html