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Lactation Information and Discussion <[log in to unmask]>
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Fri, 1 Apr 2005 10:01:32 -0600
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I would not think this is a central problem, as one of her breasts is now 
producing a "normal" amount.  But prolactin levels are more helpful if drawn 
immediately before and 30 minutes after a feeding, so the rise can be 
demonstrated. (or lack thereof)

Have you watched her pump?  Sometimes one nipple is much wider than the 
other, but you cannot tell until the mom starts pumping.  These nipples 
often appear "flat" with a little "button" of a nipple at rest.  This would 
explain why baby is only making that side sore (has difficulty getting wider 
nipple into mouth), and decreased supply could simply be secondary to 
decreased removal by baby AND pump.  Try 27 and 30mm diameter pump flanges 
and see if mom reports they are lots more comfortable, and watch for nipple 
elongating farther into flange when no longer "strangled".

The most extreme case of pump flange size causing low milk supply I have 
seen was a G6 mom who had been pumping for her 25 week premie for 3 
MONTHS...only getting drops.  She persisted because she had nursed the prior 
5 without difficulty.  When we put large flanges on her, she had a full milk 
supply in another 3 weeks.

Kathy Leeper, MD, IBCLC
Lincoln, NE 

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