Dear listmates,
I am looking for advice for a mom who is pumping only 10-11 ounces per day
for her daughter, second child, first to be nursed past a week. Posted with
permission.
Baby girl with tight frenulum at 37 weeks, BW 6-4, induced labor due to
mom's increasing BP. Treated for jaundice with home phototherapy. Underwent
frenotomy at 8 days old.
Mom pumping after feeds with Symphony, supplementing with expressed milk
with SNS at breast for most feeds, when transfer weights showed 12 to 18 cc's
transferred,even with breast compression. Back to birthweight by day 19.
Minimal weight gains over next three weeks to 7-1, at which time pedi discharged
her from home care services and told mom according to mom that she could
discontinue pumping and supplements. Weight gain of 3 ounces in next two weeks,
at which time mom contacted me again because she felt her milk supply was
dwindling. Previously she had been getting 4+ ounces total per pumping and was
now down to 1-2 ounces when she pumped in the AM for a "relief" bottle for
Dad to give. I advised resuming pumping after most feeds and supplementing
with 1 to 2 ounces EBM and/or formula thru SNS and she started fenugreek. Pedi
agreed with plan. At this point mom told me she had a progesterone IUD
inserted at six weeks check up, just prior to the baby being discharged from our
service. Milk supply increased slightly with this regimen, but transfer
weights continued to be less than 30 cc's total.
With much pumping and supplementing, baby's weight is now up to 9-8 last
week. Fenugreek and any feeding at the breast was discontinued last week by
mom's choice. Mom only getting total of 10-11 ounces per day and giving about 20
to 22 ounces of formula by bottle. Baby has always been spitty, but mom
feels that this is increasing. She wants to seek opinion of pedi GI specialist,
wants to try to increase milk supply and is asking for information on
Domperidone. Lab work for TSH, HCG, Testosterone and Prolactin were reported to
her as normal by her CNM. Do you think that there is any chance that she can
get in an adequate supply at this stage? She doesn't mind "breastmilk
feeding" as she has returned to work and her mother watches the baby and gives
bottle, now using playtex natural latch nipple. Previously used Advent. Any
suggestions or insights?
Mary-Jane Sackett, RN, BSN, IBCLC, CCE, CD(DONA)
Registered Lactation Consultant, Certified Childbirth Educator and Doula
Maternal Child Health Visiting Nurse
Pittsfield, MA
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