---- Veatch Dianne <[log in to unmask]> wrote:
>> I have been working with a Mom who had triplets at 31 weeks gestation. 
> Her history is -In vitro after 5 years of trying to get pregnant,
> bedrest for at least 10 weeks,  Unremarkable planned cesarean birth,
> started pumping within 4 hours of birth. Mom has small breasts with some
> breast changes during pregnancy.
> 

Hi Dianne:

What a frustrating situation for all of you... Any idea what underlying cause of fertility difficulty is? For example, PCOS-related fertility issues may also be related to milk production issues. Any reason for 10 weeks of bed rest (from 20-21 weeks pregnant)? And a surgical birth "planned" for 31 weeks should never seem "unremarkable" IMO. Either something was going on that delivery was planned so early -- some of which, such as high blood pressure, has been related to difficulty with milk production -- or I've got to wonder about her docs! There is also a theory that prolactin and possibly other lactation-related receptor sites or the number of alveoli are not adequate for some, especially with such significant preterm birth. In these situations, milk production slowly builds as receptor sites are thought to increase.

Did she experience signs of lactogenesis II with obvious milk "coming in"?

I still wonder if strict bed rest could contribute to lactation issues -- within 24 hours of strict bed rest, entire endocrine system appears to experience "shifts." (BTW, terrific OpEd piece on pregnancy bed rest in the New York Times dated March 24, 2006.) 


> She is now 2 weeks postpartum and has been pumping faithfully with a
> hospital grade pump. She rests, drinks, visits the babies. She was
> started on Reglan 3 days post-op because she was not able to pump a drop
> of milk. 


Hope during her visits with babies she's doing plenty of kangarooing, which is associated with improving milk production in addition to all its benefits for babies.

Does she keep a log of her pumping sessions so that she knows she is pumping a minimum of 8x/24 hours for a minimum of 100 minutes over 24 hours?  How is her diet -- is she eating well and enough? Does she do breast massage and RPS prior to pumping? Has she tried a different model of rental pump? Have flanges been checked for fit?

Wow, I'm intrigued by the starting of reglan at 3 days! I've never seen it begun so early. Where I work, we have a number of mothers who get little if anything via pumping for the first few days but lactogenesis II hits by day 5 and then they start obtaining a lot. Makes me think someone must've thought there might be a problem... Is she on any other meds?

I'm wondering if it would be worth trying a different galactogogue. Some mothers respond better to one while some others respond to another(s).  I've seen mothers who do better when they alternate, using one and then switching when milk production comes to a standstill -- often later returning to rotate through again. However, some are safer than others to try this with. Reglan requires some tapering off. (Since PPD can be higher with multiples and preterm birth, I'd be watching for this side effect of reglan carefully.)


> Now she has only be able to pump a few drops to get the shield 
> wet. Up until now we have had the "keep going" support, but it is very 
> frustrating. Any other ideas? Has anyone seen it take longer than this 
> for milk to come in, especially under all her unfortunate circumstances. 
>

The mom of quads that we wrote about for JHL several years ago obtained virtually nothing via the pump. (Her babies were also born at 31 weeks, but she'd BF a previous singleton.) Around 3 months she began fully BF one and began to BF the other 3 quite a bit. The ref is: Auer, C. & Gromada, K.K. (1998). A case report of breastfeeding quadruplets: Factors perceived as affecting breastfeeding. Journal of Human Lactation, 14(2), 135-141.

I've spoke with a number of mothers of multiples whose production went from close to nil to fairly decent somewhere between 9-15 weeks post-delivery. To be honest, I don't know how some of these women kept it going. And obviously, there is no way to know who may have this experience and who may not. I so admire a mother who does this -- don't know if I could have kept it up, especially during a time when every day can seem an eternity.

I hope you keep us posted on this MOM's progress. 

Karen

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