Hi Beth
What a fascinating, but frustrating case.
Many many years ago, I worked with a mother who had something very
similar going on, but it was hard to identify at the time. I saw her
with her first baby who just seemed not to do well due to mother's
massive engorgement. This was Zimbabwe, in the days before I had
access to pumps. Breastfeeding effectively failed due to unrelieved
and very severe engorgement and I felt dreadful about it (I know some
of you will be thinking about manual expression, but it can reach a
point where manual expression simply will not work, the "hot bottle"
technique doesn't work on everyone, and it can be very fraught....)
Mom put the baby on the bottle, but she contacted me again when she
was pregnant with her second baby. This time I had nice very
effective cylinder manual pumps, so we planned to deal with any hint
of over-fullness as the milk came in, to prevent the same thing
happening again. It worked. The baby did really well, the mother's
breasts were comfortably drained etc. But as the days went by I
became more and more convinced that something was inhibiting this
mother's let-down when the baby was at breast. He latched easily,
but simply didn't drink. He did fine with EBM by bottle, and the mom
did fine with the pump. Eventually I contacted her GP, and she
confirmed that this mother had a history of sexual abuse and
depression which could be the cause. This wasn't the only case of
inhibited letdown I ever worked with, but it was the most dramatic
and long-lasting. This mother breastmilk-fed-by-bottle for well over
a year. She got so good at pumping that she only needed to pump
about 4 times in 24 hours to get all the milk her baby needed, even
though the baby fed more often.
This mom taught me a lot. Especially that it IS possible for the MER
to be selectively inhibited, ie for a mother to let down to a pump,
but be completely unable to let down to a baby at breast. And then
she also taught me that breastmilk-feeding-by-bottle is a form of
breastfeeding that a mother with a bad history can achieve and that
she can be proud of. I became less persuasive with future mothers
who seemed not to want the baby at breast, and told them about
breastmilk-feeding as another option as early as about 2-3 days
postpartum - some of them took the bait, one breastmilk-fed three
babies before finally being brave enough to actually try
breastfeeding the third one direct and then wondered why she'd ever
had a problem! I also learned from this mother, and others after
her, that you really don't need a baby ever at breast to be able to
make enough milk, and that it's drainage from the breast by whatever
means that counts.
Beth, I don't know if the above story helps your mother. Except
perhaps to let her know that things like this do happen. I would
congratulate her on having found an especially ingenious way to
breastfeed! Is she willing to continue pumping, putting her milk in
the LactAid and then continuing to provide her milk at breast this
way? It may seem time-consuming to anyone else, but it's working
for this mom, and you say the kiddo loves the breast! Maybe it would
be an idea to just give "permission" for her to carry on this way,
rather than trying to keep aiming for "perfection" (breastfeeding
direct without the Lact-Aid). Whether the mother herself would like
to further explore what is inhibiting her let-down to the baby is
another matter. Her thoughts about negative associations might well
be accurate, but does she want to go down that road while she's busy
caring for and bonding with her baby simply to satisfy our idea of
fixing something we think is unusual?? I'd be wary of putting any
more pressure on her in that direction right now, though she might
like to work through it with a therapist at a future time....
I do hope you can follow this pair up until weaning. What a very
fascinating case. I'd love to learn how it all turns out - I think
it could go very well indeed.
Best wishes to you and the mom and baby
Pamela Morrison IBCLC
Rustington, England (formerly Harare, Zimbabwe)
----------------------------------
Date: Tue, 26 May 2015 17:53:22 -0400
From: beth mcmillan <[log in to unmask]>
Subject: Drinks from LactAid not breast
Hi all
Need some help with this. Permission to post. Challenging birth,
tongue tie baby had body work and release by very competent provider.
Baby was not at breast for weeks, mom worked hard at pumping and
baby-led bottle feeding. Baby finally did go to breast with nipple
shield, mostly for comfort. Then progressed to nipple shield and
LactAid, then LactAid with no nipple shield (yay!). Test weights done
correctly with sensitive scale show intake is exclusively from
LactAid. When at the breast, full and ready!, baby fusses shortly
after latching - of course, baby wants flow. Sooooo.....my question
is...what the heck? There is lots of milk, really lots. Babe can move
milk from LactAid with no help. Mom does massage and compression.
Where is the letdown. She herself wonders if it is inhibited d/t
stress, neg associations, etc... This mom has done an exceptional
job; built a milk supply from nothing, loved her babe back to the
breast, worked with latch, healed very damaged nipples, cried and
pumped and sweated over this. Kiddo loves the breast and is
exclusively fed at breast with LactAid with mom's own milk but then
mom has to pump for the next feeding. Please tell me I haven't just
overlooked something simple...how can this be. Mom let's down for
pump but not baby? They've both had body work, she knows about
relaxation, we've played with whether babe is just more effective
with shield (not) and tried other positions. Thoughts please?
Thanks so much
Beth McMillan IBCLC
Ottawa, canada
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