I got a referral today from an RD answering the WIC helpline.  So I  
can only help this mom over the phone as she is in another part of  
the state.  The mother has previously successfully breastfed two  
babies.  She had all three babies naturally, no meds, no  
complications.  She does not smoke and has had no breast surgery and  
is on no medication now. This baby is eight years after the second  
and the mom is 37.  Baby was born about 44 hours prior to my phone  
conversation with the mom, at 9 lb 7 oz.  Mother stated that baby was  
fine the first day but last night he started acting really fussy and  
hungry and breastfeeding every hour. She finally gave him 1/2 oz  
formula in a bottle and he seemed satisfied.  She has done this once  
again since then.  She has been pumping with a Medela electric double  
pump and getting nothing.  Sometimes it's right after he feeds but  
other times it isn't. Last night he had no wets from 9 PM to 9 AM  
this morning. Mother states that the sucking "motion" of this baby is  
stronger than that of her other two and she doesn't think that it  
could be the problem at all.  When I asked if anything was different  
about her pregnancy she said that she did notice that there was no  
tenderness or leaking of her breasts like there was with the other  
two and that had concerned her.  I told her to continue breastfeeding  
frequently and pumping and to give the supplement if needed but to  
give it in a medicine cup, dropper or syringe rather than a bottle.   
I will talk to her tomorrow. I told her that it hadn't been two full  
days yet and her milk would probably come in by tomorrow and the baby  
was just getting more alert and impatient.

Does anyone know anything about any reasons why this woman would not  
be able to produce milk for a third baby, who by her report, is a  
more vigorous feeder than her first two?  Have you had experience  
with women who were not primips and had breast changes in previous  
pregnancies but not in later ones and was that significant?

Lucy Towbin, MSW, LCSW, IBCLC

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