If she's only able to pump two ounces and she has tiny twins in the NICU (a stressful situation, compounded with a four year old at home) then it seems that the focus should be on more effective pumping -- that supply has to be waiting for those babies.  I always tell mothers that the initial engorgement, promising in the big picture, is not just milk but a "traffic jam" with milk, blood, new tissue being made, lymph and other body fluids -- that makes it hard for the milk to flow.

  So after the pumpings, doing the cold compresses for ten minutes or so, laying on her back, and doing a lubricated outward massage with her hands, from the nipple swirling around up to the neck and down the body and out past the armpit, so gravity helps drain the other fluids.  Nice breast massage video by Maya Bolman at http://bfmedneo.com/

Why "low pressure" pumping? Is it painful to bring the suction up?  Not that she needs to crank it to the max, but most women have to get the suction somewhat vigorous to be productive.  So give her lots of pumping tips -- try larger flanges, lubricate the flanges, being very hands-on, etc.  Is she using a rental-grade pump?

Is she able to get some nice skin-to-skin times with the babies?  Has she tried pumping right after they have been there, and having some practice time at the breast?  And giving her ideas for relaxation and distraction while she is pumping, hands-free -- eating and drinking while pumping, a hot cup of tea, guided imagery relaxation audios or her favorite music, a funny or romantic movie.  It's hard to get happy hormones flowing to a non-cute pump.

Good luck to the whole team.

Margaret Wills, IBCLC Maryland USA


> Date:    Wed, 19 Apr 2017 10:25:09 +0000
> From:    Wendy Jordan <[log in to unmask]>
> Subject: Prolonged engorgement
> 
> PTP, I have been helping a mom who delivered twins at 32 weeks. She had oversupply with her first who is now 4 years old. She is 2 weeks postpartum. I had her initiate breast massage for Lactation, gentle, low pressure pumping q 2 hours during the day, use warm compresses before and cold afterwards. I also recommended caster oil compresses that she intends to try today. When she pumps she only gets 20-30mls total and her breasts remain heavy and lumpy. Any avenue or strategies to check next? Looking forward to the wisdom and insight from those who respond.
> Wendy Jordan BS, IBCLC
> Sent from my iPhone
> 
>     

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