Kathy,

From your notes, I think Baby
A still goes to breast, but is really primarily AF and Baby B is
passively eating what she can by simply hanging out at breast and gets
an additional 3 oz per day AIM? 


Would it be helpful for mom to
understand that what is in her babies' best interest is also in hers?
Getting the babies feeding efficiently at breast is her best weapon
against recurrent plugged ducts. I would agree that inefficient emptying of the breast should be the priority. besides, this mom is on a rapid tailspin toward having two AF babies.? Considering her overwhelming situation, I doubt she is going to put much effort into regaining her supply once it is gone--with babies only comforting at breast, lost of AIM by bottle, refusal to use a supplementer and resistance to pumping--that cannot be far off. 

Kathy, you say both babies were clipped, but you do not mention chiro/CST. I never assume clipping will make any difference at all w/o CST. Sometimes it does, but I tell every mother that she has to have the CST appt set up for the day after the clipping. As a PT, I would think this would be a familiar concept for her. Since some PTs have issues with chiros, she could see a DO or PT who does CST. Also, have you looked at their tongues to be sure neither needs a reclipping? I would also try the shield--esp as it makes using the supplementer much easier.

As for the mom--these are my thoughts--look closely at nutrition. I don't use lecithin anymore. It addresses symptoms only. I prefer moms eat EFAs and eliminate trans fats. I think mom should be on an herbal tea that includes alfalfa and nettles. She needs to rebuild her blood while rebuilding her supply. I like MMP for marginal supply issues, but I only use the tea for really low supply. Mom makes it once per day and drinks a quart throughout the day. Simple.? And really works. 

I am not surprised that they all have thrush. Mom needs to know that thrush and plugged ducts and TT all go hand-in-hand. This really makes me suspect reclipping is needed. Since nystatin is useless, though, I think it is irrelevant that she isn't using it. I would just have her apply coconut oil to her nipples after feedings for now. And she and babies can both take a probiotic. That would only require a twice a day dosing. 

In addition, for recurrent plugged ducts, I will tell moms to have homeopathic phytolocca, belladonna (and sometimes hepar suplh) on hand. At the first sign of the plug--mom takes phytolacca and rarely needs to go to the belladonna, which you know would be used once the plug moved toward an infection. I also have the mom use castor oil compresses on her breasts at least once per day (bedtime is good--even if it is only a couple of hours). Since I have done this, no client has ever needed abx. Mom can also try drinking (diluted or not) 1 oz of apple cider vinegar per day. It is really more commonly a treatment for recurrent mastitis, but may be helpful.

Considering mom's history, I would be very interested in deficiencies in fat-soluble vitamins, esp D and in iodine deficiency. I would also have mom taking Natural Calm for the mag. I believe that the level of exhaustion many moms are overwhelmed by has to do with their poor nutrition, their deficiency in EFAs and mag and hormonal imbalances. I think of it this way--if babies are designed to wake all night, then we are designed, in our normal PP hormonal state to manage it. If we are not managing it, there is a reason for it. 

In the long run,Ii think this mom will likely wean due to the recurrent plugged ducts if she does not attend to the cause--poor feeding at breast and compromised nutrition, so that is where I would focus, while using the homeopathy for acute care. 







Jennifer Tow, IBCLC, CT, USA

Intuitive Parenting Network LLC





 






This mother of twins is also a physical therapist. She contacted me on 1/1/09, when the twins were 6

weeks old because she had been battling repeated plugged ducts. She had been treated for a breast infection 

with Dicloxacillin for 4 days then switched to Cephalexin for 10 days.



The mother had a fibroadenoma removed in 2000 and her breasts have always been tender, even before pregnancy. 

Baby A was born after 4 hrs. pushing, spontaneous labor, no augmentation or pain medications, followed by Baby B, 

13 minutes later. Mother nursed Baby A immediately after birth. Baby B needed O2 at birth, but the mother thought 

she also attempted to breastfeed her, too. The mother had surgery 2 hours after birth for a cervical tear and 

received two transfusions. Her hematocrit was 26. As of 1/2/09 her hemoglobin level was 13. She has been eating 

iron rich foods, but no supplementary iron beyond her prenatal vitamins. I suggested, but am not sure whether 

further testing has been done. Lactogenesis II was delayed until Day 6. The mother developed sore nipples in the 

first week, which resolved after a visit from a local LLL Leader.



Baby B had been gaining appropriately, although had recently slowed down, produced 2-3 large yellow BMs/day, 

along with smaller ones. She had begun hanging out at the breast almost continuously, spending a lot of time sucking 

without much swallowing. Baby A had a green BM after birth and did not stool again until day 5 when she passed 

meconium. After that, her BMs turned to green. When she was still not up to birth weight at 4 weeks, supplementation 

of 2 oz. of formula after each feeding was begun. She gained 8 oz. the first week of supplementation, but only a 

couple oz. the next week. She was sleeping longer and only feeding 6-7 times a day. I encouraged the mother to watch 

for feeding cues, and feed at least every 3 hours.



Upon my arrival, Baby B showed feeding cues, despite having been fed a short while ago. We put her to breast where I 

demonstrated asymmetric latch along with breast compression. After repeated attempts at both breasts, Baby B appeared 

satiated.



We then woke Baby A. Since starting bottle supplementation, Baby A would suck a short time at the breast and then 

begin to fuss. Suspecting that mom's milk supply was low and that Baby A was having difficulty extracting the milk, 

I suggested an SNS. Baby A nursed contentedly while taking 2 oz. of milk via the SNS.



The mother had purchased More Milk Plus tincture, but took it infrequently so I encouraged her to be more diligent 

in taking it, and to find time to pump, as increasing her milk supply would make it easier for both babies to nurse. 

Using the supplementer with both babies would ensure they received adequate amounts of milk in a reasonable amount of 

time. The mother tried the SNS for a short time, but then reverted back to bottles for Baby A and allowing Baby B to 

hang out at the breast, as that is the only way to keep her happy. Both babies sleep 5 hours at night and she is 

loathe to wake at night either to nurse or pump as she is so busy during the day



Baby A s tongue had little extension and a pronounced upper labial frenulum. Baby B's tongue extended, but did not 

fully elevate. Both babies had frenotomies performed on 1/17. Mother reported little change in breastfeeding habits 

for either girl.



Mother and babies have been prescribed Nystatin for thrush. Mother reports she has trouble applying it as

frequently as needed, as the babies keep her so busy and although tender, sore nipples are the least of her concerns.



The doctor was comfortable with their progress at their 2 mo. appt. last week, although baby A is below the 3%ile 

for weight and baby B is below the 10% ile. Mother and father are both long, lean people. Baby A is still receiving 

2 oz. of formula after every feeding. Mother reports that she has been very content. Baby B receives 3 oz of formula 

before bedtime. She is only happy while at the breast.



Mother tried wearing baby B in a sling yesterday, so she could keep her content at the breast and get things done 

around the house. She believes that the pressure of the sling during the hour she was wearing the baby has caused her 

latest plugged duct. She reports that any kind of pressure on her breast causes a plugged duct. Manual therapy 

performed on her thorax by a physical therapist set off her first plug. Wearing any of her bras, no matter how loose 

seems to encourage a plug. She will be returning to work next week and feels the need to wear a bra, so she is in a 

quandary as to how to prevent further plugged ducts. She is taking lecithin, and using heat, massage and extra pumping 

to clear plugs as they occur. Your thoughts?









 


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