I need some suggestions fast!  I tried to search the archives, but didn't
find what I needed ASAP as I am on a time-constraint.  I had a consult last
evening for a client who has a 1 month old and has not had milk production.
She has tried frenugreek and hasn't wanted to try Reglan or Domperidone.  She
has been pumping with a hospital-grade electric breastpump 5 times in 24 hrs.
 Baby will latch-on to the breast, but she has been supplementing with the
bottle because she hasn't produced any milk.  No milk sprays with pumping and
no audible swallows.  Baby is hydrated - whew!  I used an SNS to nurse baby
at breast and he took 80 cc's.  Assisted with latch-on technique.  He tries
to latch shallow and mom was very good with correcting him.  My gut is that
he never latched on deeply enough to compress the ducts for adequate
stimulation.  Mom denies hypothyroidism, passing clots, retained placenta,
etc. and did increase in breast size during pregnancy 1 full cup size.  So, I
think structurally she has the right stuff, I think she wasn't adequately
stimulating the breasts.  She'd gotten her pump from a retail site and never
instructed on its use, so she was using the inner flanges. These flanges were
squeezing her nipples flat!  So, I instructed on proper pumping
techniques.....just think, the pump was never compressing far enough back!
What a shame!  Instructed to pump at least 8 times in 24 hrs. and to nurse
baby with SNS at each feeding.  Continue fenugreek, although she hasn't seen
much improvement.  Any thoughts?
Thanks!
Carol Chamblin, RN, MS, IBCLC
Breast 'N Baby Lactation Services
Geneva, Il

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