Hello, It is not unusual for pumped milk supplies to decrease at about this
time, probably due to incomplete emptying of the breasts.  It is our standard
in our NICU to use a Medela Classic for pumping when mother and infant are
separated.  We have used several other of the "hospital grade" breastpumps in
the past and found that supply drifted down after 3-6 weeks.  The suction
curve that the Classic uses seems to have better emptying effect.  All I know
is I don't have to suggest as much Reglan as I did before, and I'm doing much
less xeroxing of our Reglan packet.  I'm going to assume she's double
pumping.  Also, she needs to pump much more frequently--milk production is
based on milk removal.  So, if it's not being removed, her body won't bother
making it.  Another thing I suggest when this happens, or even at the
beginning--massage of the breasts while pumping.  And I invite dads to do
this--gives them something to do other than cleaning pump parts, and God
knows, they don't mind(even have gotten a few silly grins when I've suggested
it--real stress-buster--and it's hard to be stressed out when your breasts
are being massaged!).  Breast massage does increase removal of the milk, as
shown by a study published last year.  I forget where, but I believe it was
done in England at North Staffordshire Hospital.   Also, this baby needs to
go to breast, and do as much skin-to-skin as mom can do.  Again, I don't care
whether the baby gets any milk, but the positive image of her baby at breast
will do wonders.  Bring the pump to the baby's bedside. I find that milk
removal is enhanced by looking at the baby and having the baby"at the diner",
even if he doesn't eat.  Also, I remember reading about back massage helping
let-down--I think it's done in Japan and there are pressure points involved.
I don't know where they are--but I tell dads to let me know if they find a
particularly good one--more silly grins.  Laughter is a stress-buster.  Be
light, be funny.  Go for her self esteem--tell her how nice she looks, how
pink and healthy her baby looks, how her baby is getting cheeks on both ends.
 Don't put pressure on her to pump--that just increases her stress, just try
to make it as easy as possible for her.  Good luck, Maureen Allen RN, BSN,
IBCLC
PS. By the way, all this touching and fun is good for the marriage.  Do you
know that parents who have had a sick infant in the NICU are at greater risk
for divorce???

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