I'd like some feed back from other LCs who have worked with mothers of large
families.  I have a mom with 7 kids, oldest 12 yr old.  She successfully
nursed the first 5 for about a yr each.  Baby #6 is 16 mo.old, looks
perfectly healthy with no hx physical or speech dev. problems and no striking
physical anomolies.  Mom exper. lact. failure and ftt with this infant after
uncomplicated home birth.  Went to formula after much struggling.  Baby #7
was referred by midwife on day 11 when down 10% .  I saw on day 12 after 24
hrs formula supplementation and some recovery of weight.  Birth weight around
8 lbs. again, uncomplicated home birth. No elevated bili, no striking oral
features.  Suck is decent off finger -- esp. if fluid is being delivered.
 Suck at breast is terrible, even when well positioned, even with feeding
tube. Shuts down after a few tries, stays latched but no swallows, only a
scant (like .2oz) gain after 20 min. at breast.

Mom is healthy, not particularly stressed (I know, she has a large family,
but they seem happy and well-cared for, and she looks real balanced to me.)
 She feeds freq.   The most striking hx is absence of major breast changes,
brief low-level engorgement on about Day 3 which rapidly resolved to rather
flacid state. At this point, she pumps about 1/2 oz each breast each feed.
Prior to seeing me, she was not pumping. Breasts look a bit pendulous, with
the glandular tissue kind of dropped down toward the tips. Pressure
involution on glands?  I had a kind of Lactnet dinner with Cathy Liles, Kathy
Dettwyler and Julie Moy.  When I shared this case, we got to talking about
dairy herds and about women with lots of kids and wondered whether  lots of
births would have an effect on the breast which would cause it to lose
capacity with parity.  I personally breastfed non-stop for  12 yrs. so I
don't think just duration would do it.  I've only had 3 births in that time
period compared to her 7.  Is that the issue?  I feel a real lack of
knowledge due to decline in family size reducing our chance to observe
effects of multiparity.  What would make a tried milk producer suddenly
under-produce?  No evidence gest. diabetes.  She looks pretty healthy for
thyroid probs. Beautiful hair and skin. Appropriate weight.  Willing to let
baby nurse ad lib.

For the record, I had her pump like crazy, continue to breastfeed, use
feeding supplementer with all the milk she could pump. Baby could not make
feeding tube work at breast, only off finger.( I observed nipples to be
meaty, almost calloused.  Is non-compressibility the issue?  Did parity
affect this?)  Baby only gained .9 oz after 3.5 days of this rigorous effort.
She is still pumping (with classic in double mode) but has abandoned the
feeder as too time consuming and is supplementing with ABM by bottle.  She
still bfeeds ad lib.  I need to check the weight this week to make sure ill
baby isn't the problem. Pedi check was ok.
Any insights will be appreciated.
Barbara Wilson-Clay, BSE, IBCLC
priv. pract. Austin, Texas