Laura

What a wonderful case history you've given...... 
except you don't give the baby's weights.  I find 
that underweight babies simply don't breastfeed 
well.  And they don't breastfeed well until they 
regain the weight they should have put on if all 
had gone well right from the beginning.  If you 
could send this baby's birth weight and current 
weight, maybe it would give us more of the 
picture.  Meanwhile 21oz a day, 630 ml, does not 
sound a lot of milk for a weak-ish baby to be receiving.

Also, just one more thought - is it at all 
possible that while mom can let down to the pump, 
she can't let down to the baby and that's why 
you're not seeing any milk transfer without the 
SNS?  I know this is very unusual, but I had a 
client once who experienced this, so it does happen.

Pamela Morrison IBCLC
Rustington, England
-----------------------
Date:    Wed, 8 Jul 2015 16:02:35 -0400
From:    Laura Spitzfaden <[log in to unmask]>
Subject: Milk Transfer Difficulties

PTP. I am working with a mom of a 3.5 month old. 
This is her second child. She had difficulty with 
her milk supply with her first so she sought me 
out as a LLL Leader when her newest baby was 2 
weeks old and not gaining well without supplementation.

She has reactive hypoglycemia, so I shared 
information with her about insulin resistance and 
myo-inositol. This seemed to help significantly 
with supply but she was pumping and using a SNS 
to feed because her baby was not transferring well without the help of the SNS.

She decided to see me as an IBCLC when her baby 
was 6 weeks old. Baby had some cranial molding 
and a tendency to turn to one side. She had a 
choppy suck and did not much engage her 
temporalis muscle while feeding. She also had 
restrictive lingual and maxillary labial frenums. 
She did not transfer well at the breast though 
Mom had available milk. She only transferred well with the SNS.

Mom followed through with multiple visits for CST 
and a frenectomy of both restrictive frenums. I 
have had excellent experiences with both 
providers. The CST provider thinks that Baby is 
dependent on SNS and is not used to working for 
the milk. I feel like there is more to it.

A follow-up visit showed improved tongue mobility 
and good sucking on a finger but I could feel a 
lot of pressure on my finger from Baby's upper 
gums. Transfer was not any better.

Mom is still pumping 9x a day and feeding 9x a 
day with the supplementer at 3.5 months. Mom 
reports that when she tries to challenge Baby 
with slower milk flow from SNS, it results in 
poor transfer for the rest of the day. Mom weighs 
before and after feeds with a scale sensitive to 
10 grams which is not ideal for accurate transfer 
amounts but gives a pretty good picture and the 
amounts transferred correlate well with weight gain.

Mom has tried goat’s rue, iron, b12, magnesium, 
and moringa but did not have success with these 
increasing supply. She has only had success with 
the myo-inositol. She recently increased the 
amount she takes and it has given her a boost in 
supply. She produces a total of 21-24 ounces a 
day and supplements with 1 or 2 ounces of formula 
every few days to maintain weight gain.

Does anyone have any suggestions for continued help for this dyad?

Laura Spitzfaden, LLLL, IBCLC


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