Hi Wendy,

Regarding <<17 days post partum and can only pump 1 oz per 24 hours>>
First, reassure the mother that she *is* breastfeeding and can
continue to do so. Good she is using the lactation aid (SNS). If you
go back over her history you might find the reason for her low level
of production. The red flags would be breast or chest surgery (heart
surgery as a child?), hormonal aberrations like PCOS and some kinds of
infertility, medications including some herbal or over the counter
products that are anti-galactagogues (birth control shot?), retained
placental fragments, less than full term infant, delayed initiation of
bf, tongue tie or other oral anomalies, and breast anomalies (do the
breasts appear and feel well developed and firm?). If you are able to
approach her about possible psychological trauma, that could be
playing a part. Some of these would be amenable to treatment
interventions. If you are not able to find a likely reason for her low
milk production, you can still offer to her some options.

Those might  be
1. continue bf ad lib and use the SNS (or a homemade lactation aid -
my personal favorite) with supplement.
2. continue or add or change galactagogues - I generally recommend
More Milk Plus and/or reglan (I have not seen many side effects in my
clients on reglan and usually see a milk increase).
3. Add in double pumping with a hospital grade pump (usually rented)
as often as is practical or manageable.
4. Mother can try CST for herself and baby or other bodywork
modalities (of which I am not very familiar, really) or even
acupuncture which I am even less familiar with.

Personally, if I had the finances and under the same circumstances as
this mom, I would try all of it. Also I would encourage mom to
continue, as many women see an increase in milk production over time,
it can take 6 wks for example.

Laurie Wheeler RN MN IBCLC
Mississippi USA

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