Jennie
Welcome and good luck with your studies.

The questions you raise are excellent and the answers can be very 
complicated. ["Why can I only produce 1-2 oz. of milk from both breasts when 
I pump?  She wants so much to breastfeed her daughter, but through nursing 
and pumping, the baby is not getting satisfied.  How can I encourage her to 
keep trying...? Is this normal as a first time mother to produce so little?]
I will try to give you some ideas about what is going on.

First, it is *possible* that she is thinking she is not making enough milk, 
but she really is. The baby's behavior of wanting to nurse alot may be 
misinterpreted as abnormal when it is normal. She may be scheduling her 
baby's feeds somewhat or using a pacifier instead of nursing. She may be 
judging her milk production based on pumping which can be misleading. In my 
experience, MANY store-bought pumps are of very poor quality and do not 
extract much milk. Mothers make varying amounts of milk and have varying 
storage capacities and therefore need to feed their babies differently. This 
is an area just bursting with new research and the answers are not all in 
yet. I have seen some healthcare staff tell very new mothers in hospital to 
pump to see how much they are getting or to pump to stimulate the milk and 
when the mother gets just a little, this kills her confidence. The mother 
may get into a rut of pumping rather than responding and bf the baby.

However, NEVER doubt a mother who says her baby is not happy nor satisfied 
and do evaluate the situation right away.

Second, she may indeed be making too little milk. To explore this can be 
very involved. Here are some things to consider: observe position and latch 
- often it is impossible for baby to extract much milk due to extremely poor 
pos/latch; maternal history of endocrine or other medical problems; breast 
size, shape, growth; medications; breastfeeding patterns - when did she 
initiate, how often etc? Lactogenesis II or did the milk come in? In my 
experience, moms get very full breasts on day 3 or 4 and can express several 
oz of milk at that time, like 3 oz or more each side. Then there are baby 
factors like prematurity, near-term gestation, tongue-tie, poor latching 
etc. Did the baby lose alot of weight, become jaundiced, how is the voiding 
and stooling etc. Inadequate or infrequent emptying of the breasts can 
quickly lead to a downward spiral of chronic low milk production.

Based on a thorough evaluation, recommendations can be made such as: respond 
to the baby and nurse much more; fix the positioning and latch; intensive 
pumping with a top quality pump; supplementing at the breast or by other 
method. Close followup is usually indicated.

Laurie Wheeler, IBCLC, MN, RN
Tupelo MS, s.e. USA

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