Moe writes:

>I've been working with this mother and her baby since newborn and 
>breastfeeding has been going on just fine for the both of them until 
>2 weeks ago when the mother suddenly mentioned that her right side 
>breast was having an episode of plugged duct due to an ill fitting 
>bra.


Have you seen the plugged duct? It's not clear whether the condition 
is still there now. Sometimes, lactating breasts do have minor 
transient lumps and bumps, that present no real problems and 
disappear.

>
>I've prepared a feeding plan for her to follow which consists of 
>frequent feedings, lots skin-to-skin contact, babymoon, adequate 
>intake of liquids and maintaining a healthy balanced meal. I've also 
>thought her how to hand express and had suggested that she hand 
>express right after every feed, especially on the affected (right 
>side) side.


The frequent feeding, skin to skin, babymoon is of course fine for 
any bf mother at any time :) :) Her intake of fluids and healthy 
eating will not impact on the breastfeeding much, but might make her 
feel better (she does not need to drink more than thirst/inclination 
suggests).... unless she gets stressed wondering if she is eating 
'right' :)

>This was done 5 days ago and until today, she has yet to be able to 
>produce enough milk when pumped for her baby. She was able to pump 
>3oz from both breast prior to this. Her baby is now 1.5months old. 
>The baby has already been fed some formula for several feedings as 
>the mother claimed that the baby fusses and gets angry when she is 
>being offered the right breast. My conclusion from this is that 
>perhaps baby is fussing because of the missed fast flow, or there 
>might be a change in the taste of milk (salty perhaps) due to the 
>plugged duct episode.

If she has been offering formula,  her milk supply will certainly 
have dwindled.  Expressing milk is *never* a good indication of how 
much milk is being produced or how much milk the baby gets, but if 
she feels she is making less this is the main reason - the use of 
formula.

>
>The mother's concern is that she will be going back to work in 1 
>month time and she is worried that she wont be able to provide a 
>storage of EBM for her baby and would need to supplement with 
>formula. The mother is also worried about being able to sustain the 
>feedings solely on her left breast as her baby feeds about 4oz and 
>always seems to want to nurse after a bowel movement (which is 
>totally normal in my opinion)

If she wants to feed one-sided, then she can do so, but it seems to 
me very early to think this is the only option.

As ever, if she wants to increase her milk supply, she needs to feed 
often and effectively - and that means dropping the formula.

Mothers cannot build up and maintain a supply of breastmilk if they 
are also using formula. That's just biology.

Building up a stash of breastmilk in the freezer in these early days 
is probably not necessary - she's going back to work in a month 
[aaaaargh! ridiculously EARLY! but I know maternity leave is poor in 
the US :( :( ]. Get breastfeeding going well, and she can use the 
pump a bit, and then when she is at work she can get a routine of 
pumping at work. She doesn't need a stash.

In fact, if she has a tendency to plugged ducts, the extra 
stimulation of the pump on top of full breastfeeding might even lead 
to the plugged ducts.

Hope this helps!

Heather Welford Neil

NCT bfc, tutor, UK
-- 
http://www.heatherwelford.co.uk

http://heatherwelford.posterous.com

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