Dear Yvonne,

A few comments and questions.  This mom is already nursing about 10x a day, so I wonder how often you expect her to pump in addition to this?  Is there any problem with the baby's latch/suck which would decrease his effectiveness at the breast?  There seems to be a lot of weighing going on.  How is the baby doing?  He sounds pretty normal with some evening fussiness - not unheard of in any newborn.  How is the overall weight gain and development?  Why does this mom think that she has a problem to begin with?  Has her pumping become less efficient with the new pump - perhaps she has a pump problem rather than a supply problem.

If baby's weight gain has been very poor (< 3-8 oz/week on average), then you may really have a situation here.  Thyroid levels may need to be tested again, now that her dose has been adjusted.  She may need to try a different galactagogue or add something like goat's rue, blessed thistle, fennel.  If mom is experiencing low milk supply in the evenings, suggest she make a real effort to relax and put her feet up in the late afternoon with a light snack and a drink.  Is the baby latching and sucking correctly?  If baby is sucking well and frequently, then pumping will not help much, if at all.

This sounds like a confidence problem with the mom as much as anything.  What kind of support is she getting in the home?  Does she have contact with LLL or some other support group?  She may be convinced that she will have problems because of the thyroid.  Or it may be that the baby that is contributing, but you are focusing on the mom side of the production problem.

Sorry if this seems a bit disjointed.  More of my just before bedtime musings - just can't seem to resist a little Lactnet before retiring.


Warmly,
Sharon Knorr, BSMT, ASCP, IBCLC
Newark, NY (near Rochester on Lake Ontario)
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