Dear Lactnet,

In March I began counseling the 43 year old mother of a one month old
who called me with a concern about milk supply. This mom has two other
grown children, one of whom she breastfed for two years.  She has given
me permission to post her experience on Lactnet.  We are hoping for some
insight into this seemingly confusing and (as is always the case)
convoluted situation.

When the mom  first called, she was recovering from a flu that had
lasted for some weeks. She told me that she had a history of severe
anemia.  Fatigue had precipitated giving supplemental bottles.  My first
thought was that the bottles had contributed to a decrease in milk, so I
suggested that she work toward eliminating the bottles—including the
supplement, if she could—and go back to exclusive breastfeeding.  I
suggested pumping to her at that time, but she decided she wanted to
wait and see.  After eliminating the supplemental bottles, she still
found that her baby wanted to be on the breast all the time,  nursing
and dozing.  More than just nursing a lot to increase milk, this
ultra-frequent pattern has lasted weeks and months.  Nursings overlap,
one into another.  The baby also wakes a couple of times at night, again
wanting to nurse at length.

When I first saw this mom, the baby was not latching well, with pursed
mouth and clicking. I offered suggestions for better positioning, giving
the baby postural stability by keeping him flexed, working toward a
wider latch, and using breast compression.  I suggested to the mom that
the baby might be trying to make up for a less than optimal latch/suck
by nursing all the time.  She opted to rent the pump.  I suggested she
pump after feedings, if she could (difficult if baby is wanting to be on
the breast all the time), and to try to manage pumping and nursing at
the same time.

Looking into her milk supply concerns, the mom also shared with me that
she had had fibrocystic breast disease with two lumpectomies in the
years since she nursed her last baby.  The lumpectomies were done on the
breast she feels she gets the most milk from.  She has also had PID, but
this has been resolved for some years.  All other items on the "list of
common reasons for low milk" (apart from improving latch/suck as I
mention below) we crossed off.

Five weeks or so later, the mom now feels latch is improving, but it
seems to require all of her attention to help keep baby latched
well—simultaneous pumping and nursing is difficult because of this.
Baby was, and continues to gain fairly well (4 ounces per week, on
average), and has a good number of the right color/consistency poops and
wet diapers.  After one week of not very frequent, but simultaneous,
pump/nursing (twice a day) mom expresses a total of two ounces of milk
per pump/nursing session.  I am not sure if this is a good amount or
not.  Mom is not pumping a lot, but she is pump/nursing which one would
think would give her the best results.  Most likely, if baby stayed
latched well throughout the session, the amount of milk expressed would
be more.  True?  Last I spoke to her, because she was ready to quit
pumping,  I suggested what I call "catch as catch can" pumping—pumping
for two minutes every hour, as in every time she walks past the pump.  I
felt a little silly suggesting this, since I wouldn’t think it would
give any better results than pump/nursing, but she seemed to be
intrigued and said she would try it.

All things indicate that this baby is growing *OK*.  Mom is resigned to
the non-stop nursing, but she wonders if her baby could be nursing
better/growing better/sleeping better.  Of course, she would prefer
this!  She wonders if she can increase her milk supply, or if her
medical history combined with the baby’s lackadaisical latch/suck has
made this too difficult.  Drugs to increase milk are out of the question
since doctors are uninformed about them in our area.  Mom is also not
interested in fenugreek since her doctor told her that there are no
studies that support it’s use for increasing milk.  Just FHI, I gave her
Jack Newman’s info on domperidone and a couple of articles on fenugreek
from Lactnet sources.  She had heard about Reglan from someone else.  It
was the drug she mentioned to her doctor, who "just said no."

I have looked through all my LLL resources, my files, and searched
Lactnet.  I feel my troubleshooting abilities are used up.  Any helpful
feedback would be very much appreciated.

Thanks,
Diane D, LLLL from VT

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