Hi, Susan.
I have some thoughts about this, but can't seem to get them into
logical order, so I'm just going to type them out, and hopefully they'll make some
sense.
Maybe you can find another food baby will take, and maybe not. In
either case, mom needs more milk, if possible. I don't know what the
breastfeeding medicine specialist suggested as far as pumping, but I would definitely
suggest this mom get up once in the middle of the night to pump, even if baby
stays asleep. There seems to be something about that prolactin spike in the
middle of the night that affects all-day supply in the early months. Logic says
that if stimulation at night stops, then supply at night lowers, like when moms
stop pumping during their work shifts but keep breastfeeding when they are
with the baby. But even so, I've seen that when nighttime stimulation stops too
soon, often daytime supply is affected as well.
Have you suggested the "regular food" galactogogues to this mother?
Foods that have a reputation for increasing supply include papaya, almonds
(handfuls of whole almonds, not just a few slivers on salad or cereal), oatmeal.
While not a "food", brewer's yeast has also helped some moms.
I am wondering why pumping so much has been suggested. If baby was
feeding well, as seemingly indicated by his early weight gain, then the suction
has been applied (except at night) and something else is needed. Many
4-mo-olds won't stay on an empty breast to help rebuild supply. Instead, they will
back off when the milk runs out and look at mom with betrayal in their eyes,
sort of "What did you do with the rest of it?" In those cases, mom needs to
pump to build the supply when baby won't. But this baby is staying at breast for
long periods, so unless his suck is incorrect, I don't think additional
pumping (other than at night) is going to have much effect.
I have seen babies who don't like dealing with strong letdown suddenly
stop gaining at 4 months. It's as though they really hate dealing with
drowning, so they start self-pacifying by sucking on their hands/fingers. Feedings
become more spaced, and mom just thinks baby's getting a bigger stomach so
can go longer between feedings, and does not realize this isn't normal. That
may have been where they got into trouble, but now he seems to want to be at
breast a lot, so that should still have been able restore supply. Often moms
report that they notice a significant drop in production in the two days before
or the first two days of their periods. But this mom's has run its course and
been over for 3 days already, so that can't be the sole reason for the low
supply.
Has this mom had any bloodwork done since the baby was born? I got
anemic during my first pregnancy. Even though iron supplements got the
hemoglobin level looking normal by the time my baby was 2 months old, the *stores* of
iron didn't get built back up for months. By 4 months, I was unable to keep
up with my son's needs. Had a different doc for baby #2 who paid more
attention to me, I didn't get anemic, and I was able to totally breastfeed baby #2 for
9 months, when she could finally tolerate solids without getting sick. In a
breastfeeding mother, a serum ferriting test is a more valid test than a
hemoglobin. If doc agrees to run the test, as long as they are drawing blood, they
might want to run a current thyroid panel as well.
Hope you and this mom are able to figure out some things that help the
supply problem.
Dee
Dee Kassing, BS, MLS, IBCLC
Collinsville, Illinois, in central USA
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