As you might imagine, I see this situation a LOT.
It depends on the mom and the specific situation. But if they have not been
removing milk well for weeks, I will explain that I can help them make a
plan for optimal milk removal, herbs, etc, and we shall see where we can
get. I always emphasize I am here to help her, not judge her, and she gets
to decide when she has had "enough". I tell her as long as she is making
progress (ie slightly more milk) she can keep looking for more. I usually
do not tell her of my worries that she has involuted a LOT at the first
visit...so I do not plant a negative suggestion. But if it becomes clear we
are getting no more milk after week or so of trying, I will explain the
process of involution, and there is a REASON she cannot get her supply to
come up. It is not that she is not trying hard enough.
I have a mom like this right now...first saw her at 3 weeks. She makes
about half her baby's needs, but at 6 weeks he still goes to sleep at the
breast once the flow slows, and she has never pumped very often...hates it.
So I had her try an SNS about one week into working with her, because she
really wants to breastfeed, but hates to pump. Saw her today, and baby took
2 ounces from her and 2 from the supplementer, and she is fairly happy.
But I never say "never". I once saw a mom who had a baby born at 24
weeks...and had been pumping Q3 hours for 3 months, only getting drops. Had
5 previous babies, and nursed them all. Kept asking the nurses why she
wasn't getting more milk, and they told her it wouldn't come in until her
due date!!! (Yes...in a NICU) So she came to see me, saying "Honey, I KNOW
I can make milk! I nursed 5 babies!" So I watched her pump with her 24 mm
flanges, and the nipples did not budge down the flange. Put on 30mm flanges
and got 10cc. A mere 3 weeks later, she was pumping 3 ounces at a time.
I sometimes tell this inspirational story to moms...because I really cannot
explain it physiologically. Why didn't she involute after 3 months of
stasis???? I believe it must have been "mind over matter". She KNEW she
could make milk.
Kathy Leeper, MD, IBCLC
Medical Director, MilkWorks
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