HI!  I am fairly new to lactnet. I only posted once a while ago.  I am an RN
and have been IBCLC for 2 years.  Most of my experience has been inpatient
where I have been supporting mothers in nursery and level II SCN.  I have
recently started a private practice in the community with a partner.

I am dealing with a mom who delivered a full term male on Thurs. 6/6. She
delivered vaginally with a vaccuum assist.  Baby had a moderate right sided
cephalohematoma.  The first day, baby was sleepy and really didn't nurse
much.  Mom said baby latched on and went to sleep.  On the second day, Fri.
baby latched on and nursed about 10 minutes per side q3h.  Mom and baby went
home Saturday.  Mom, Dad, and baby  are stayiung with Mom's Mother for 1 year
as Dad is hear on business for only one year.  Mom's brother was getting
married that day and it was quite hectic in the house.  She said  baby
refused to nurse.  She also said baby nursed better on mom's right breast
where hematoma was barely touched.  Anyway,  baby cried/screamed at breast so
mom gave a bottle with ABM. and didn't pump.  She tried pumping on sunday and
also tried to put baby to breast to no avail.  She was pumping with small
battery-op. pump and she said she only got a few drops.  I saw her monday
night.  I had her pump with hosp. grade pump and when milk was spraying out
we attempted to get baby to breast.  He did latch on for few sucks but did
not suck strongly enough to effectively milk the breasts, then he either fell
asleep or cried at breast which upset mom.  On exam baby had a perfect
breastfeeding suck on my finger.  I taught parents how to finger feed whcih
baby did beautifully.  Mom did not want to struggle with baby at breast so
she opted to finger feed while she increased her supply with a double pump.
 i told  her to try putting  baby to breast when somewhat satiated because he
was frantic and crying at breast when hungry.  Baby did well finger feeding
but mom unable to increase her milk supply.  She double pumped every 2-3
hours during the day for at leas ten to 15 minutes and on tues and weds got
only 1-2 ounces for the entire day.  I suggested she try increasing pumping
time to 20 - 30 minutes which she did.  She started bottle feeding on
thursday as she was discouraged due to low milk supply and baby would only
lick or take one or two sucks occasionally after a feed and sometimes cried
at breast.  By sunday one week of pumping mom only pumped 2 1/2 oz. all day
and she decided to give up and returned the pump.  She is taking no
medications, she did have an epidural during labor.  She said she had very
little breast changes during pregnancy from 34b to 38b, areola and nipple did
darken during preg.

My question is this,  Is there anything else she could have done to increase
milk supply?  She also said her cousin had the same problem, minimal milk
even after pumping and nursing.  Any thing I missed?  Thanks in advanc

Caren Goldstein RN IBCLC