It appears that women are quickly derailed very easily by early  
breastfeeding that is less-than-ideal. Your particular client may have some 
underlying hormonal or glandular issues, but more to the point may have been 
her nicu situation and delayed and/or infrequent pumping, and likely 
inefficient feeding by the baby. I am sure that women with "borderline" milk 
production capability are impacted even more.
Here is what I would consider, in addition to your plan:
Extra pumping with a top-notch pump, I favor the Medela Classic. Check 
flange size during pumping and perhaps try larger nipple opening size. 
Baby-wearing and cosleeping for around the clock frequent feeding. Herbal 
and prescription galactagogues if no contraindications. Screen for 
medication use, especially contraceptive pills, patches, shots and "cold 
preparations" like some OTC allergy pills or decongestants. Screen for 
anemia (maybe already done in blood work). Screen for pregnancy (unlikely). 
Did she have very obvious breast fullness during first week? If not screen 
for retained placenta (unlikely). Evaluate her lifestyle with her and can 
she discontinue any things that are keeping her and baby apart, like is she 
a type "A" personality who is trying to do to much for herself, her family, 
and/or others at this critical time. Rest and feed mama nutritious foods.


Laurie Wheeler, IBCLC, MN, RN
n.e. Mississippi, s.e. USA

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