Cindy, The mom's supply may be only temporarily reduced with the recent high progesterone level just before her period started. Since mom already started fenugreek, I can remind her that it seems to work only after a threshold dose, which makes her taste and smell like maple. Dr. Newman's handout recommends blessed thistle in the same doses to help the fenugreek work (my interpretation). One mom I worked with who pumped 40 ounces a day for a year (yes, 4O) took fenugreek an hour before pumping to boost the effect. I never asked if she took capsules or tincture and have now lost track of her. Is the mom double-pumping with her double pump, or is she trying to eat with one hand and pump with the other? Do the pump flanges fit properly, or are they now too small or too big? It would be wise to use vacumeters to check out her Pump n Style. If it is working well, there is no need for the rental. I often recommend power pumping. This could look like double
pumping every hour possible for 5-10 minutes, or she may pump for 10 minutes, rest, then pump again in about 20-30 minutes, then wait her usual interval and do it again, sort of mimicking cluster-feeding. Also, switch nursing (back and forth at least twice) can stimulate supply. Can mom add in some brief nursings, such as before leaving for daycare and then AT daycare before leaving for work? (And the reverse.) Is baby nursing at night? Co-sleeping and nursing at night (includes co-bedding with continuous access) helps supply. Breast massage before and during pumping apparently does more than just help letdown.
Another important part of counseling a mom who has (or perceives) reduced supply is to determine if she is doing anything to reduce supply. Is she on a calorie-restricted diet? Did she just start the pill, the shot, the patch or a coated IUD? Did she just night-wean? Is baby eating before nursing (a weaning strategy)? Is mom trying to be super woman and have a clean home for company and doing lots of holiday prep (holiday weaning)? Is she taking in sage, parsley, peppermint, decongestants, bupropion, nicotine, alcohol in any form? Could she be pregnant? (I know, the period. Stranger things have happened.) Is baby too busy or nosy to nurse?
These are the ideas to that come to mind right now. I would also mention the joys of nursing a toddler. Nursing SAVED me, especially during those times my darling was especially contrary! And for bedtime. Nothing better.
I hope some of that was helpful. Merry Christmas!
Rowena Tucker MOM, LLLL, IBCLC
Bryan, Texas
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