June,

I don't have any answers in regard to the "what" of the medication part.
Is your decimal point accurate in the thyroid medication? Or is she just
being reduced by only 0.25 mg. daily? I presume that's in response to
medical testing results and the dose is in line with her physiological
needs as the doctor judges. I have read it numerous places that
medications or herbs of any kind just will not do the trick without
regular, frequent and effective milk removal. I suspect that milk
transfer could somehow be improved. I think it's important to avoid
"projecting" the power of an "Alice in Wonderland effect" on to herbs or
medication without emphasizing the primary necessity of efficient milk
removal.

These are some of the thoughts that sprang to my mind. I realize that in
your part of the world, and everywhere the message has been spread, that
there are those who are fully convinced that there are no milk sinuses. I
am just as convinced that there are, tiny reservoirs though they may be,
and I continue to make use of them in teaching and locating and
demonstrating them in practice.

<hrly expressing =
after each feed .>

Sounds daunting and discouraging in itself. Certainly not sustainable
during the whole 24 hours. She needs some sleep. Precisely how many times
in 24 hours is milk being removed by hand or pump? Can the baby be heard
swallowing during feedings? Does the baby have a good latch and all the
appropriate jaw movements and swallowing and pauses that go with it? Is
the baby willing to go to the breast without complaint? Or is the baby
beginning to complain, and is that why she didn't put the baby to breast
over the weekend, but tried to transfer milk with a pump?

<on the left side gets 20-30 mls ebm depending on the =
time of day. and maybe 5mls from the right breast.  she dosent  =
experience  let-down on the left side also.>

If she gets 20-30 ml. from the left side after breastfeeding, then she
must be having a let-down-actually, on both sides, since it is hormonal,
and the oxytocin travels in the circulation, therefore to both breasts.
Just because she may be unable to feel any sensation doesn't mean she's
not having a let-down. The milk sinuses do not contain that many cc.
collectively. She could only get that much if it were being moved from
the segmental ducts forward by some degree of MER, no matter how weak.
She could easily stimulate a MER by use of Reverse Pressure Softening.
Post to me privately if you want directions.

Is she using breast compressing and massage in conjunction with
expressing? Have you personally observed her expressing? Many of our
mothers are amazed how easily and how much we get when we demonstrate a
more effective technique, such as the Marmet, after checking to see how
they have been expressing. Many don't get behind the sinuses, and or they
somehow miss the best place to compress. Many mothers have sinuses that
are set more deeply than they realize. This also effects choice of the
best size pump flange.

<She mentioned that over the weekend she pumped instead of putting baby =
to the breast and only got 60mls .>

Why? If the baby is suckling effectively, s/he is more efficient than any
breast pump can be, and probably more than effective hand expression. Is
she using a supplementer while nursing to give the breast more suckling
stimulation, and the baby more practice at getting reward from the
breast? If all else fails to bring up the supply to meet all the baby's
needs, it is still possible for them both to get the hormonal, dental,
etc. rewards of full breastfeeding with the use of the supplementer, or
by using Dr. Jack's home-made one.

All this is a very subjective subject for moms, the moreso if they are
getting frantic and discouraged. I think some of her assessments cannot
be taken at face value but must be checked by your own observation and
"hands-on" help to get more objectivity.

I hope this gives you some useful ideas.

Jean
***********
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html