I must be on a low milk supply trend this month. I am used to things in
threes, and was hoping I would be dealing with the threes with the same causes
too for ease of problem solving. But, I am instead getting to have threes
with three different causes!
What impact would being a gymnast as a young woman have on later milk
production capability? This mom did not have her first menstrual cycle until late
in her 15th year, and then they were always irregular and sometimes only came
every few months and did not last long. She used to bind her breasts tight
to appear to have none. They were not that large to begin with. During her
pregnancy, she did not need a larger cup size, though they did appear a bit
larger and her areola darkened. She gave birth via emergency c-section with
general anesthesia due to pre-eclampsia at 36 weeks. She pumped, but in the
early days she was mostly out of it and unable to do much. Her baby was in
NICU and she pumped only a few times a day. (Don't know why she missed the
part about pumping more often, because I know where she delivered is extremely
breastfeeding supportive.) When she was with the baby, she breastfed. Her
baby came home, she had sore nipples. We fixed the latch. At the time, the
baby's weight was fine. Intake for the age and size of the baby was also
fine. However, now the baby is 7 weeks old, and mom is concerned because the
weight gain is slow and the idea to give formula has been mentioned more than
once. She 'feels' her breasts are not producing enough. The baby beats her
chest and cries at the breast within a few minutes of feeding, mom can only
express with a hospital grade pump less than an ounce and there are never any
'streams' only drips of milk. She finally started supplementing with formula
because the baby was truly unhappy and her breasts felt completely empty.
When she came to me this time, the baby was able to get 54 ml combined from
both breasts after more than 2 hours since last feeding at the breast, but it
took more than 30 minutes, lots of breast compression and a very not happy
baby. An hour and a half later baby only took 8 ml from one side and 2 from
the other and was extremely agitated and showed obvious signs of hunger. Mom
not able to express even a few drops.
Mom's blood work all came back normal. When I get these clients with low
milk supplies I am starting to "hope" for thyroid issues so there is at least a
reason and then when we don't have an easy reason, I am frustrated for the
moms because it also means no easy fix.
Plan is: feed the baby at the breast as she is already doing, but to go
ahead and continue with the supplementing as she is doing (she is not giving
much formula, but it is enough to have allowed the baby to have some happy
content times) and lets wait and see what happens. She is going to use an SNS.
Since the baby is so unhappy with the flow, I am hoping with a little more
flow the baby will be happier to suck more than a few minutes and mom won't have
to be nursing, pumping, feeding, etc. She is going to have an ultrasound
done next just in case there is a reason why her breasts just feel so flat and
empty. Even after the she has had a few hours of rest, she still does not
feel full and the most she has ever been able to express even when she first
wakes up is less than an ounce from each breast. She is already taking herbal
galactagogues and is reading more about pharmaceutical options. She is very
well informed and is willing to do whatever it takes to be sure her baby is
breastfed, and supplementing is very heartbreaking for her.
I know we have discussed before that the idea insufficient glandular tissue
should be rare, but is it really rare? Or is it that in the past not many
women were breastfeeding so it was rarely seen, but now as the numbers are
increasing we are going to see it more frequently? I know I can definitely
'feel' the difference in breasts that are full and making a lot of milk and those
that seem to only barely dribble and moms are working like crazy to keep the
supply capable of making at a maximum.
Anything else she can try? I just want to cry with these moms who are
wanting to breastfeed, who know it matters, and have to struggle just to do what
so many others take for granted and others don't even bother to try.
Thanks,
Pam MazzellaDiBosco, IBCLC, RLC
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