Impending mastitis can cause milk production to suddenly 'tank', 
continuing to express and nurse will bring it back as soon as she is 
better.

Catherine Watson Genna BS, IBCLC  NYC  cwgenna.com

On 1/20/2013 10:46 PM, April Rosenblum wrote:
> Hi everyone,
>
> I am supporting a mother (a friend) who gave birth 2 weeks ago. I saw them
> at birth, helped with latch, supported her over the phone through difficult
> engorgement, but now things have taken quite a turn. She has given me
> permission to post & get your ideas.
>
> Birth to day 11 - Great milk supply
> - Lactogenesis II noticeable at 48 hours
> - Baby lost 2 oz at discharge - exclusively breastfed
> - Baby quickly climbed above his birth percentile on the WHO charts
> - Mom pumped more than breastfed because baby was extremely fussy at breast
> (not sure why - didn't get to see them then). Pumping schedule was every 2
> hours with up to two 4-hour stretches overnight
> - Typical pumpings = 3-5 oz. Mom could hand-express a full bottle in a few
> minutes.
>
> Day 12 to 14 - Supply suddenly disappears
> - On day 11 mom took *one* dose of Benadryl (diphenhydramine) for an
> allergic reaction to fruit.
> - Late on day 12 mom noticed she could pump almost nothing - a quarter
> ounce at most
> - Mom switched to breastfeeding and baby was initially satisfied.
> - I saw them day 13. Baby had many audible swallows at breast but the scale
> showed transfer of only 1 oz and afterward wanted to nurse again and again,
> no swallows heard. Mom could express only drops. Denied pain.
> - Today, day 14, mom is making even less than yesterday, despite best
> practices to increase supply (maximum skin to skin, pumping plus hand
> expressing after feedings, continual massage with feeding, etc.) Now baby
> is no longer audibly swallowing at the breast. Today her whole breast hurts
> during feedings.
>
> She began giving him formula this morning. Now offering "breast for
> dessert," lots of S2S, pumping when he bottlefeeds.
>
> I know there is no research data confirming that Benadryl reduces milk
> supply, but enough IBCLCs have mentioned it from clinical experience that
> this seemed to be our best explanation. From the few things I've found on
> Lactnet, it sounded like once stopping Benadryl, she could expect her
> supply to return with good stimulation - but it's gotten worse.
>
> The only other thought I had was Mammary Constriction Syndrome ala Edith
> Kernerman. I've had it myself so I know it can cause breast pain and
> reduced flow. In a sense she fits the profile because she is attached to a
> very awkward breastfeeding posture, leaning forward over baby with a
> hunched back.
>
> So my questions for you:
> 1. If this is related to taking one dose of Benadryl, what are your
> experiences with how LONG it takes for milk supply to rebound?
> 2. If this is MCS, can anyone share with me a description of the pec
> stretches, scapular squeezes and massage that Edith recommends? I've lost
> my notes from Edith's lecture.
> 3. Is there some other explanation for such a fast, dramatic drop in
> supply? She denies any form of contraception, pseudoephedrine, or other
> medication.
>
> Thank you!!!
> April
>
> Philadelphia, USA
>

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