Let's not put the cart before the horse. I see so many cases of 
"insufficient milk" that really belong in the category of not nursing 
often enough, not nursing long enough, and giving lots of bottles in the 
first days. Long epidurals before and after birth make those babies 
willing to latch but often not suck (or too sleepy to latch or suck). 
Yes, mom needs to be followed up and perhaps her thyroid problems may 
cause low milk supply. So does her age, but if she is getting pregnant 
the old fashioned way without medical help, she appears to have good 
hormones. I would do weight checks on baby the first 2-3 days and chart 
bowel movements. I would have someone show mom how to latch baby on 
properly and show her what active sucking looks like. Drugged babies 
often do not suck well enough to transfer milk and this is also called 
"not enough colostrum" etc. On day 3-4, mom could have the IBCLC do test 
weights on a feeding and see what baby is removing -- especially if the 
weight checks and diaper counts are poor. I would only do the 
creamatocrit thing as a last resort. I think test weights would be more 
appropriate intervention in the beginning. See how much milk baby is 
transferring if the weight gain is poor or weight loss is high and 
diaper counts are poor. Remember too that if baby gets any formula, the 
diaper counts are no longer useful. Formula throws them off and makes 
them look better.

Also, as a mother of three, I know how busy we get. I have worked with 
many, many mothers of more than 2 children who forget to focus on the 
new baby and so don't nurse enough or long enough. This is not meant as 
criticism but sometimes mom needs to be reminded to feed baby every 2 
hours and monitor diaper counts. I have had so many mothers of many 
children admit they forget to feed baby often enough like they did with 
their first or second baby, and if they get a passive or quiet baby, 
he/she doesn't eat enough.

Kathy Eng, BSW, IBCLC

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