If it's a uncomplicated pregnancy, you could explore with her the idea of antenatal hand expression -- sharing the article by Sue Cox. It's also discussed in "Making More Milk," -- another resource to share
Each pregnancy and each baby is a new deal, so she may be surprised that she has some head start on subsequent lactations.
Making her feel that she's on common ground -- every new mother needs to keep the baby close, lots of skin-to-skin to welcome the baby to the world, and feeding early and often and effectively. Given her history, perhaps hand-expression onto a spoon after many of the feeds the first couple days (and offering to the baby), Then, as she is able (leaving the pump assembled in the refrigerator, washing twice a day) start pumping after as many of the feeds as possible. She is telling her body that she has "twins." The "triple duty" with breastfeeding/pumping and offering that milk is not a lifestyle one can do long-term, but it helps keep the demand high during the early calibration.
Sometimes it helps to convey that *changing* the amount of milk takes crazy demand, and that at some point one shifts gears to the less strenuous process of maintaining the supply -- building the factory vs. just running it day to day. That why, under ordinary circumstances, the early weeks are so intense, and then as the baby's intake starts to level out (and they're smiling and enjoying other things) the daily routine calms down.
It might be useful to discuss and help her be familiar with the idea of at-breast supplementing, which is a fiddly process, but easier with practice. If it really seems like supplements will be necessary, even getting comfortable with assembling and trouble-shooting the equipment, filling it with water and putting it on, during the relative calm of the pregnancy. (It does seem that long-term users like the Lact-Aid, but the assembly is a bit fussier.)
Conveying that in special circumstances, it's not that the milk "comes in" and that's the end of the story -- that she may need a campaign of frequent effective milk removals and other supportive measures to push the available tissue into higher productivity. Depending on what's happening, supplements can be a tool to buy time to push the supply. Helping the baby get bigger and stronger makes them a more effective dance partner in this.
IGT is not a black/white situation -- but it is a physical challenge that has been unfairly dealt to her -- it's no more her "fault" than someone who is having difficulty walking or seeing without glasses -- we have a right to be angry when our bodies don't work the way they should. And that in a world where some babies never get a drop of milk, or a minute enjoying being at the breast, everything she's doing is valuable for her baby. In special circumstances, breastfeeding might not be an all or nothing situation.
All mothers find it a challenging transition to having more than one child in the house -- so thinking about what touch points of the day are important for her and the older child and where other people can help. And through the babymoon, the practicalities of having help for daily life so she can focus on this campaign -- sadly sometimes more of a fuss, and the free casseroles being brought over, etc. is made for the first child, when one needs the help even more with the second go-round.
Margaret Wills, IBCLC Maryland
.
On May 23, 2015, at 12:04 AM, LACTNET automatic digest system <[log in to unmask]> wrote:
> There are 2 messages totaling 64 lines in this issue.
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> Topics of the day:
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> 1. Prenatal treatment for hypoplasia?
> 2. Breastfeeding with a defibrillator
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> Date: Fri, 22 May 2015 08:26:29 -0400
> From: SUBSCRIBE LACTNET Jacalyn <[log in to unmask]>
> Subject: Re: Prenatal treatment for hypoplasia?
>
> I just had a Mom with this. I would be interested in more information as well
> So far for the Mom I had, at first weight check post discharge the baby's weight was stable. (not >10%)
>
> During her hospital stay, I did discuss with her the potential for inadequate supply but to continue frequent feedings. She did immediate skin to skin and spent much of first 24hrs skin to skin. She did have breast changes with pregnancy, so remaining hopeful for her. She was surprised...shows the lack of breast assessment prenatally :( Fortunately she attended the prenatal BF class and knew skin to skin, early feedings, feed on demand.
>
> I would encourage this mom- skin to skin, frequent feedings, pumping early if poor feeds.
> Hopefully, one of the LC experts will provide us both more information :)
>
> I referred to Breastfeeding and Human Lactation 4th edition - Riordan & Wambach and Breastfeeding Atlas 5th edition- Wilson-Clay & Hoover. sorry not good at actual links.
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> Date: Fri, 22 May 2015 13:50:34 -0500
> From: Indie Pereira <[log in to unmask]>
> Subject: Breastfeeding with a defibrillator
>
> Are there any contraindications to breastfeeding with a defibrillator or
> special care that should be taken?
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