I hope I am not missing something here, and clearly breastfeeding is 
not going well for this mother, but I don't think the low milk supply 
is totally  unexplained.



>  She lost a lot of blood and had low blood pressure, low hemoglobin, 
>and low temperature, so  baby went to the normal nursery for 48 
>hours, during which time she had some glucose water and several 
>bottles of 20 mL formula after she lost 10% of her weight.


There's one cause of low milk supply there - separation of mother and 
baby for 48 hours with no expressing or feeding.

>   Mom initiated nursing on Day 3.   She did not pump in the 
>hospital.   She initiated pumping on Day 5 when I saw her, with a 
>Lactina and 30 mm breast shields.


There's another cause - baby already on formula, prob doesn't feed at 
the breast very much if at all, and no  pumping till day 5.
>Baby was pretty sleepy at breast, which I attributed to slow milk flow


...or being full of formula??

>
>I saw her for a follow-up on Day 7.  She feels much better, but 
>still not 100%.  She reported that she had pumped 4 times and got a 
>total of 1.5 oz.


4 times in 2 days??? But that's nowhere near enough to make up the 
shortfall caused by ineffective bf.

>  Baby is currently taking about 1.5 oz of formula about every 3 
>hours.  She has also been breastfeeding at every other feeding.


That might be no more than a handful of times a day.


Yes, I think there is more to it than simple separation, plus baby 
full of formula, plus infrequent feeding and infrequent pumping, plus 
engorgement, plus ineffective feeding....after all, some mothers do 
produce quantities, even with all this against them.

But this mum has not been bf physiologically, and when that happens, 
the physiology simply may not happen.

Or am I missing something?

Heather Welford Neil
NCT bfc, tutor, UK

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