Pat,
Congratulations on your new grandbaby. Is the baby a boy or a girl? I 
ask, because boys generally need more milk.

It sounds like your daughter is doing pretty well, but perhaps there are 
a few things that can make her pumping more productive so her milk 
production continues to increase so that she calibrates to a nice high 
supply. We'd like her to be making about 23 oz a day by 2-4 weeks in 
order to be able to sustain production long term and have a generous 
supply when the baby goes to breast.

First, confirm that she is using the pump most effectively. Many moms 
start out on fast (high cycles) for a few seconds to stimulate an MER. 
She should try turning the cycles down to about medium once she sees the 
first drop of milk from each nipple, and turn the vacuum up slowly to 
find the setting where her milk sprays out, but that is still 
comfortable. She should pump both breasts simultaneously, and a two 
second breast massage right before pumping has been shown to be helpful 
as well. If the first MER wanes and she does not get another one in a 
minute or so, she can turn the vacuum back down, and the speed back up, 
or take the pump flanges off and do a tiny bit of massage again, until 
she gets the next MER. I encourage moms of preterm infants to pump for 3 
MERs per pumping to ensure that the breasts are well emptied.

If her nipples turn white or red at the base during pumping, larger 
flanges are available. The nipples need room to expand in order to let 
milk out!

She can also try temporarily pumping for about 10 mins every hour during 
the day for 1-2 days to increase milk production. I think she might do 
better if she gets a little more sleep at night, perhaps pumping every 
3-4 hours at night may be sufficient.

Also, check her kit and make sure the valves are still working well 
(each kit comes with 2 complete sets of valves so they can be easily 
replaced if one rips). And if none of the above works, consider getting 
her a Lact-e or SMB to use at home, the metal piston makes a difference 
for some moms.

Best wishes,
Catherine Watson Genna, IBCLC  NYC

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