Dear Dawn,

Good luck with this mom.  I have just been through this with a mom - many
phone calls and home visits (and done as LLLL, so no money - she wouldn't
have paid anyways, eventually stiffed me on an SNS to boot).  This was
also a very nice lady, very low income with a husband who insisted (red
flag!) that she should breastfeed but wouldn't help out with anything
around the house or with the baby.  They did rent a Lactina which I
thought indicated that she was serious about getting back on track.  I
think that she, also, in the beginning, really did want to nurse this
baby, but had huge breasts, no support and a big baby boy that everyone
was telling her from the start she would never have enough milk to feed
completely.  The visits would go well, we would devise a plan, by phone
she would indicate things were going well, but within the week, it would
all fall apart and she would really only comply with the plan for a day
or two.  She would almost never call me.  Perhaps if I could have called
her every single day, twice a day, or moved in with her for a week, it
would have worked......

I did explain to her that there was a minimum amount of pumping and/or
nursing that would have to be done or there just wasn't going to be any
increase in milk production and that it would, in fact, continue to
decrease.  I think that it is important to make that clear and to give
ownership of the situation to the mom.  Your mom needs to ditch the
bottle completely and nurse frequently with the SNS or at the very least,
must accompany the nursing/bottling with at least six good pumping
sessions per day.  If she is not willing to do this, then she doesn't
"really" want to nurse this baby.  If she is not willing or able to do
this, then you can congratulate her on her efforts to date, encourage her
to continue to nurse the baby whenever she wants to, but let her
understand that her supply will continue to diminish and will certainly
not increase, no matter how many galactagogues she takes.  Don't let her
make you feel responsible for her inability to comply - there are no
magic wands here.  Moms in this situation need to make a committment or
the results just won't be there.

I must admit that I still feel badly about my mom.  It was one of those
cases that just wore me down and in the end, I felt depressed about it
and wished I had done some things differently.  On the other hand, by the
end, I also realized that there were some underlying issues that I had
absolutely no control over and that probably doomed the whole effort from
the start.  And so it goes.  Don't beat yourself up over this.

Warmly,
Sharon Knorr, BSMT, LLLL, IBCLC in Newark, New York (near Rochester)
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