greetings,
i would love input on the following situation:
i have not seen this mom yet, but will see her tomorrow, and have spoken
with her several times by phone.
second baby, one week old today. failed at attempt at breastfeeding first
son (now 2 1/2) due to (it seems) multiple factors related to low milk
supply with undefined origin. lc with son suggested reglan, but that is
the point at which mom threw in the towel. this baby girl lost 11% of
birth weight by day 3 and doctors urged formula supplementation. mom is
giving half of recommended supplement (, struggling to breastfeed every 2-3
hours (baby very sleepy) and pumping as well, with a good double pump.
she has never gotten more than a few ml from pumping, and baby falls asleep
at breast after 3-4 minutes, albeit mom reports "gulping" for those 3-4
minutes. sometimes switching sides gets a couple more minutes, sometimes
not. bountiful wet diapers, but skipping days stooling (formula related
constipation or insufficient calories?). weight check today. pre and post
feed weight check last thursday (day 3 of baby's life, so not surprising,
necessarily) revealed indetectable milk transfer.
mom never felt engorged, but did increase a cup size or so (started at an A
cup) during pregnancy, and got a little fuller after birth. baby receiving
approx 8 oz supplement per 24 hr period - per baby's own cues: refuses
more. supplement was via cup, but after talking to me 2 days ago, started
giving all supplement at breast with syringe. mom reports baby loves to
nurse, and isn't fussy at the breast the way her son was - just
sleepy. according to mom, baby suck well on finger and at breast, no
obvious tongue tie (per mom), and gets a fairly good latch, though could be
more open. mom was sore first few days, but not anymore, which is also in
contrast to her first experience (pain and visible signs of nipple trauma).
medical history: depression and post partum issues with first baby, but
not this one, no thyroid problems (although i recommended a possible
thyroid test), no hormonal issues, no problem conceiving, no surgery, PCOS,
diabetes, blood pressure issues, etc. normal vaginal delivery with a brief
epidural, mom doesn't think she has retained placental fragment. husaband
is a doctor (internal medicine). mom reports breasts that are small but
not obviously differing in size from each other. i have not asked about
shape and structure - thought i'd assess that visually tomorrow.
the long history and now my questions:
how often do you all see insufficient milk with no obvious medical
reason? at first i thought baby just needed to nurse more, and get more
calories, but mom got a new pump and had no more success with that one than
her old one, and coupled with no engorgement, problems with first baby, and
weight loss with this one, i am beginning to wonder if there is some
not-so-obvious hormonal issue at work here. when i visit tomorrow, i will
look more closely at the possibility of PCOS, thyroid, theca-lutien cysts -
any other suggestions? lactogenesis II should occur even if baby is not
nursing long enough or vigorously enough, and since pumping is producing
next to nothing at 7 days post-partum, i am concerned that this is not just
a baby-originated issue or a breastfeeding management issue. have any of
you ever seen moms who are pumping with a decent pump, and pumping
correctly not be able to pump * anything* but still have a good supply when
baby is at breast? besides a digital oral assessment and latch/positioning
assessment, an assessment of pumping technique and strategy, a look at
moms breasts for possible insufficient glandular tissue development, and a
possible hormone/endocrine panel, how would you all approach this
situation. mom is taking a galactogogue tincture recommended by the
hospital LC (a tincture i am not familiar with), and is very motivated, but
understandably distraught. i am awaiting the weight check today to tell us
how this baby is doing on just 8 oz. of supplement (baby weighs about 7
pounds).
sorry for the very long post - perhaps some of you have some light to shed
on this issue of insufficient milk supply.
Thanks in advance
Lyla Wolfenstein
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