Dear Catherine and Jennifer,
Thank you so much for your replies and insight!
As for the oversupply, baby was coughing, gagging and  pulling off the
breast at beginning and sometimes during feeding, and spitting up after
most feeds, milk everywhere! I found that mom was pumping after every feed
(as a result of earlier latch issues, she was protecting supply but had not
backed off pumping when supply increases and she became engorged). I
encouraged her to first back off pumping at night, then after a couple days
to only pump (or better yet to hand express) if baby didn’t nurse well
and/or she was feeling uncomfortably full.
Baby is gaining well but at this point is not nursing, mom is only pumping.
According to mom (who lives 45 min- hour away from me unfortunately) baby
got fussy at breast at the same time that she was unable to pump much.
 I have repeatedly asked mom about comfort with her pump and flanges which
she says is fine and encouraged breast massage with, and hand expression in
addition to pumping. It’s an I had not considered that lack of discomfort
might not mean the flanges were right for her. She’s wound pretty tight
(tense) so I have also wondered about let down problems and encouraged
calming breathing, visualization with pumping.  She is very keen to take
the supplements but I am afraid of further muddying the waters with her
thyroid.  I am not as familiar with moringa or shatavari --but found that
Moringa has been reported to have anti-thyroid effects.
Speaking of the thyroid levels, AGREED Jennifer -- I am getting her levels
2nd hand from mom- not directly from the physician.  I need to establish a
relationship with local endocrine specialist but I honestly am at a bit of
a loss with the various levels and where they should be postpartum- *if
ANYONE has a good reference(s) for thyroid (and prolactin levels) I would
most appreciate. *She sees an endocrinologist where she lives but I doubt
they are familiar with the specifics of milk production!

Date:    Wed, 7 Aug 2019 15:02:12 -0400
From:    "Catherine Watson Genna BS, IBCLC" <[log in to unmask]>
Subject: Re: Low supply even now that thyroid is normal

How is baby's growth? If the baby is growing well on breastfeeding when
mom is home, but mom can only get a little milk with the pump, it could
be a pump/breast fit issue. Does she get more if she manually expresses?
Does she have very elastic nipples? Pumps seem to work poorly for
mothers with elastic nipples, because the nipples get drawn so far into
the nipple tunnels that the nipple pores get pinched off and milk does
not flow well.

If baby is not growing well, then perhaps mother's prolactin levels have
dropped too low to maintain lactation. The interactions between the
various hormones are somewhat complicated. Some mothers turn T4 into T3
more slowly than others, and even with T4 supplements are low on T3. If
this is the case, they often feel exhausted and have difficulty
thinking. Thyroid hormones are important for breast tissue
differentiation (creating milk glands) and if a mother has low thyroid
hormones during puberty or pregnancy, they can have difficulty
maintaining milk production.

Finally, what were the indications of oversupply? Was milk spraying from
6-7 nipple pores at once? Was the baby gaining much more than the
optimal amount of weight?

For now, figuring out a way to remove milk effectively might help,
prolactin stimulating medications might help. Hopefully mom has access
to a good breastfeeding medicine physician or endocrinologist to try to
tease this out.

Catherine Watson Genna BS, IBCLC  NYC  www.cwgenna.com

Date:    Thu, 8 Aug 2019 05:17:01 +0000
From:    "Jennifer Tow, MA, IBCLC" <[log in to unmask]>
Subject: Re: Low supply even now that thyroid is normal

Molly,IME, it's very unusual for doctors to order all the labs necessary to
adequately assess thyroid function. This often leads to overmedication,
which can result in estrogen dominance. I am always suspicious of "normal
thyroid" unless I've seen the numbers myself or know the client has seen an
ND or functional medicine doctor/nutritionist. The herbs she's taken don't
make a lot of sense to me either. Why hasn't she used moringa or shatavari?

Jennifer Tow, BFA, MA, IBCLC, RLC, CSOM

Intuitive Parenting Network, LLC

Holistic Lactation Consultant, Holistic Health Coach (focus in nutrition),
founder Holistic Lactation Institute


On 8/5/2019 8:29 PM, Molly McMillion wrote: (original post)
(PTP) I have a mom of a 4 month old who really wanted to nurse this baby
(2nd baby) especially after first had  “reflux” and terrible “allergy” issues
with formula. She was doing well, even had a little oversupply at 2 months
so I had her cut out pumping and just nurse. Kicking myself now because she
returned to work a month ago and has struggled to pump  even 1-1/2 oz total
for the day while away from baby. She has hypothyroid and we’ve chased her
levels (up and down) for months. She is now in the normal range, but milk
supply is further dwindling. She is currently pumping on average 9-11 times
in 24 hours and  begging to take supplements especially Fenugreek but I see
that it is a “no” with thyroid issues? She’s tried fennel, blessed thistle
raspberry leaf and dill with no increase.
Suggestions? Thoughts on thyroid issue?

Molly Scarborough McMillion RN, BSN, IBCLC, LCCE, CPST
International Board Certified Lactation Consultant, Lamaze Certified
Childbirth Educator
Project Director, West Virginia Breastfeeding Alliance
Special Projects Consultant - West Virginia Perinatal Partnership
304.667.4362

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