Hi lynn,
I am not sure if there was an earlier post, but I read that a mother with
Pcos has an infant who stopped gaining after 2 wks, but who had gained about
an ounce per day during first 2 wks. It sounds like she had problems with a
previous lactation, since  you stated fenugreek didn't help much with the
last child. You also say she is feeling like she makes 16 oz of milk per
day, but can't get anything by pumping. Perhaps she is thinking about the
amount she is supplementing and extrapolating that she must be making 16 oz.
I didnt' get the gestational age and birthweight and current weight of the
infant. It sounds like you have a good plan going with the lactaid and some
galactagogues. Here are my thoughts.
Did she have an abundant supply early on? I find that mothers usually get
quite full, heavy, and somewhat hard breasts 2-4 days postpartum and babies
typically have a noticeable increase in their swallowing at breast and
diaper counts. If she had the big milk surge, then it *usually* is a baby
problem, and with poor milk removal and/or infrequent feeding, or use of an
ineffective breastpump, the good supply quickly goes down. The baby issues
need to be addressed and treated if possible.
If she never really got a big milk surge, then it "usually" is a mommy
problem like insufficient glandular tissue or hormonal aberrations. It can
be a combination, like today I have a pcos client with pronounced hirsutism
and a baby with quite a classic tongue tie.
But back to your client. Has she taken any birth control products, shots? Is
she on any other medication even otc meds even tylenol p.m. which I think
contains benadryl? I've had that come up once or twice.
What I usually do to help manage these situations is to have a consultation
to get the full detailed history and early bf practices. Then observe a
feeding, get a pre/post weight. Ask alot about the feeding, is this one
representative in any way of the usual feeds etc. IMy plan would be: I would
ask the mother to pump with a hospital grade pump after as many feeds as she
could, and feed frequently of course. I would assure deep latch and good
positioning, and breast compression. I usually recommend a tube supplementer
at breast, for supplements of her expressed milk and formula if needed. Some
moms opt for bottles. Herbs and prescription galactagogues if the situation
warrants, due to very low supply. The alternate is to forego the pumping and
use just the lactaid so that baby is breastfeeding often and increasing her
supply that way. I think the pumping part can make the supply come up
quickly but it is more work for the mom and sort of a Middle Man between the
mother an d baby.
I do find that if mom is using an effective hospital grade pump like ameda
elite, ameda lact-e, medela classic, medela symphony then her expressed milk
output usually correlates with her actual supply. So if she cannot express
any milk, I would say her supply is exceptionally low. Can she hand express,
because that is certainly fine to do, as there are moms who do not let down
to a pump, but then the baby's weight would not be a problem, she just
wouldn't be able to pump at work, for example.
I'm not sure I've said anything new or helpful to you, but hope something
can be useful.
Laurie Wheeler, RN, MN, IBCLC
MISSISSIPPI USA

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