There are lots of moms in this situation of wondering if they'll be able to make enough milk. When I see that doe-eyed look, I ask her how she decided to breastfeed. (Not "chose." "Decided" is more definite). As she mentions each of the reasons, I gently elaborate talking about how right she is because that reason is so important.  This gets very emotional and I keep affirming her emotions about the importance of every drop of milk and every feeding interaction.

We talk about how everyone raves about the importance of the immunities in colostrum, but how, at 16 mo, the immunities are in greater concentration than they were back in the colostrum and how we don't know if that's because the 16 mo old is taking less than the 4 mo old or if it's because nature knows the 16 mo old is out in the world more and needs more protection.  But what if it's because the quantity of milk is decreased?  Then whatever milk this mother is making is like a powerful shot of immunities at each and every feeding. That's not something to be lightly dismissed.

We talk about the importance of having as much of the perfect nutrition that nature planned for him as possible because there are many good things in breastmilk that haven't been identified to be put into formula.  We want him to get as much/many of them as possible. 

In this case, I won't call formula "the fake stuff" like I do in unemotional situations where the mom is randomly offering it~~~like not bfdg because guests are in the room instead of kicking them out-gggrrr.  Instead I remind the doe-eyed mom that her milk is perfectly designed for her baby and while sometimes formula is necessary as a carry-over, it's still always playing catch-up with this, that, and the other being added to make it "new & improved." And again emphasize the importance of getting every single drop of milk her body can make.

We do lots of elaboration on the closeness and security bfdg offers and some discussion that if she has to use formula to still feed him s2s and switch sides and use paced fdg to be as close to bfdg as possible.

As Laurie said there's no crystal ball, but that doesn't matter.  This mom is a breastfeeding mom in her heart and soul (because *she* has told me all the reasons she's breastfeeding) and we're going to help her max out whatever her personal capability is. And that's the goal, maxing out what she can do.  We also talk about how it gets better with each and every baby, so don't think past history is a limitation and consider this experience preparation for next time.

We're too grossly understaffed to initiate calls, but we tell her that she can call us as often as she wants; we strongly encourage LLL; and we point her to Diana & Lisa's www.lowmilksupply.org so she knows there are many mothers in her situation and there's a whole website just for them.

To me, keeping her emotions supported are the key here.  Even if she doesn't establish a full supply, she knows that her efforts are worth it and is proud of what she did instead of feeling like a failure for not being able to make enough milk.

Debbi Heffern
RD, IBCLC, LLLL
St. Louis, MO
 

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