Hi,
        Talk about timely!  I got a call this am from a mom back at work 4
weeks now using a PNS.  Has called me twice now about feeling like she can't
pump enough... Could get 5oz the first few times and is now down to 2oz per
pump which isn't meeting the child's need.  In addition the now 4month old
had only gained 1/2 pound since her 3month check... the same month as the
pumping and mom working started. Family MD is not worried. Baby had been
gaining 2lbs/month up to that point. Mom is very concerned and I think it's
more than a coincidence that this drop in weight gain is going on during
this first month of separation... Baby is now fussy at the breast and mom is
wondering if she is beginning to prefer the bottle? Mom also reports no
feeling of let down (since birth), rarely ever leaks from opposite breast,
rare gulping and swallowing, etc signs of low MER...
        Now the question is... what can this mom do? We've tried visual and
olefactory cues, massage, fenugreek, pumping while the baby is nursing on
one side evenings and weekends, nursing one side only at night and pumping
down the other while baby feeds in the am (that got a temporary boost in
quantity).  I've suggested more frequent pumpings during the day (she had
cut down to once while at work) for shorter periods (three ten minute double
pumping sessions vs one 30 minute session), lots of skin to skin evenings
and weekends, napping after work while nursing, bathing and nursing for
bedtime, etc.. Put her on 24 hour nurse a thon for this weekend, suggested
going to sippy cup with valve vs bottle, hold off on intro of solids until
supply issue is resolved (baby not showing solid readiness cues)....We also
talked about her stress and tension factor, the more she worries about how
much she'll be able to pump this time, the less she'll probably pump...and
using relaxation techniques to help,  but she's got no back up stores left
and is facing Monday with no milk to send for baby.  She is adament that she
doesn't want her child to get formula.
        Money is an issue, she borrowed this pump and can't really afford to
buy or rent one, but I'm thinking that might make a big difference if she
could?

Suggestions I haven't thought of?

Thanks,
anne
Anne E. Robb, MAT, LLL
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Tangent, Oregon