Another update on the three discouraging insufficient milk cases.

1) The mom with the infertility history only pumped maybe 4 times a day
and did not follow through on contacting her OB for a blood panel. I sent
an MD report, but no response.  At 2 weeks postpartum, mom just didn't
feel like trying anymore and acknowledged that she had not done
everything possible, but just wasn't up to it anymore.  We discussed her
next baby, which she is planning soon, and I encouraged her to get her OB
to address this in between so that she would know whether it was worth
trying to bfd again; she is already gun shy of disappointment with a
second baby.

2) Mom with no colostrum had her milk come in Thanksgiving eve (4 days
pp?) and now is overflowing with milk, baby very happy. Yay!  They came
in yesterday to buy a pump for when she returns to work; all going well.

3) Fifteen yr old mom came in yesterday for another consult. Baby is 2
weeks old, mom doesn't think this will ever work. Original problem: Baby
3 wks early, mom toxemic, mag sulfate (I read all your stuff on this,
Barbara W, and feel it probably applies to mom and baby), latch problems,
delayed and dribble lactogenesis. Grandma breastfed her own kids long
term and wants her daughter to breastfeed, especially since mom and baby
are NOT eligible for WIC due to living at home and grandparents would
have to buy formula.  Mom had wanted to breastfeed, but with
difficulties, she has *not* been cooperating, has not been pumping more
than once a day, and feels that if she breastfeeds it would all be on her
shoulders, whereas if she bottlefeeds, she'll "have help".  Mom doesn't
want to nurse baby at night, or pump at night. Hmmm.  Big conflict
between mom and her parents.

Baby is not latching on, but once I put milk in a nipple shield, he
started doing it and even pulled milk that the pump did not get (I double
pumped her and only got milk to cover the bottom of one bottle-- supply
negligible). I am pretty sure that the lack of supply is the major issue,
and that if the milk is there, he'll learn to breastfeed without too much
more difficulty. However, devices like the SNS would not work here
because the mom was not cooperative in molding the breast to help baby
latch, and she would definitely not be one to work with the intricacies
of getting an SNS just right. Breasts need more stimulation, but my other
concern is that mom has some early evidence of possible hormonal problems
(she has somewhat masculine features, hairy abdomen, heavy, periods every
2 mos) that may also inhibit her ability to produce a normal supply. It's
so hard to tell without a good effort first.

I talked first with the mom to see where she is at.  She had not wanted
to put the baby up for adoption though her dad had suggested it, hasn't
wanted to give the baby to her mom, who is happy and willing to raise as
her own since she had had a hysterectomy and didn't feel that she
completed her family( grandma is even willing to induce lactation).  Mom
seems to have an unrealistic view of parenting and is making decisions
based on her convenience and perceived needs;  she was not expressing
empathy for baby's needs. She wants to go back to regular high school,
not the minor parent program, and leave the baby in the care of other
teenagers on campus all day.  She wants her mom to do the night feeds,
and I suspect that more would/will slip in the future.

I then talked to grandma and expressed to her that I was even more
concerned for her daughter's ability to be a parent than I was about the
breastfeeding. I also expressed my belief that mom needed to take total
care of the baby 24 hrs a day, bottle or breast, because her current view
of the situation was skewed to make breastfeeding look like more work.  A
plan was worked out to ask this mom to give breastfeeding a real try; her
attitude was "I've already tried and it isn't working", but in reality
she has not followed through, and has lied to her mom.  Mom and grandma
agreed to the following plan: mom to pump 8 times a day for one week, and
must read "Breastfeeding Pure and Simple" (she had no prenatal bfg
education-- for "informed consent" decision) before she can stop pumping.
If she doesn't have a decent supply started by the end of these two, and
she still doesn't want to breastfeed, she may stop.  Grandma will be
monitoring mom's mothering, and if mom doesn't feed baby often
enough/appropriately, will discuss with her whether she really is able to
be a mom to her son.  I also encouraged them strongly to get another
appointment right away with a counselor to assess the situation and how
to handle it further.

I've never been in the situation of mom #3 before, and was wary of
feeling over my head. Grandma was looking strongly to me for advice and
guidance, and I found myself in the position of wanting to advocate for
all three.  I didn't want to force a mom to breastfeed, I didn't want a
baby to be neglected just because he wasn't convenient, I didn't want to
side with one person over another.  Hard stuff! I told grandma that I was
talking out of my gut, that I did not have expertise with crisis
pregnancies, gave her my best suggestions and begged her to check them
out with another counselor.

How would you all have handled mom #3?

-Lisa Marasco, BA, IBCLC