Jan Barger describes a mother with a great deal of post partum swelling who
has difficulty getting her baby to attach to breast and who does not have
much/any milk.

We see such cases all too frequently.  I am currently working with such a
mother and we are a bit over two weeks out....still scant milk.  This is a
mother who BF her 3 year old 18 months.  We saw her 48 hours after d/c and
put her on a feed-the-baby-and-pump plan due to over 10% infant weight loss.

(Two days later when she went to the ped for regular baby weight check, the
doc says weight better so no need to do all the bottle supplementing, just
BF.  This is a new doc who has not yet learned to stick with the medical
and leave the feeding to us!!)

As you all know, when the supplementing (read feeding) stopped the crying
and weight loss started (read starvation).  Mom had no milk as she was
still swollen.

The plan for this mother is typical.  She will breastfeed up to 15 mins. if
baby interested and vigorous.  If baby does not want to nurse, okay.  After
the opportunity to BF, baby goes to helper for an Avent bottle feeding
while mother double pumps for 15 mins.  Mom's care plan indicates that she
is to save any pumped milk for baby and use commercial baby milk only when
her milk is not available.  I tell them to keep feedings less than 45 mins.
and that they only need to be that long when there is no help since bottle
feeding (by dad or grandmother) can be done while mom is pumping.

In addition, mother is to drink 3-4 cups of mother's milk tea per day to
help reduce swelling and to take fenugreek (5caps 3X day) and blessed
thistle (2 3X day).  She is to call her physician to see if he/she wants
her to take med to reduce swelling.  We don't have milk anyway, so the
diuretic can't make things much worse is my thinking and we need to get the
swelling taken care of before we can get milk.

I will have her come back for a follow up appointment in the lactation
clinic for an intake measurement before stopping the bottle supplement.  I
generally like for them to tell me that they are not having to use the
commercial milk in the bottle for a day or two before the intake
measurement is scheduled.

I do not know what to do about these cases of delayed or suppressed
lactogensis due to edema.  We are seeing them more and more.  I usually
explain to the mother that when her feet go down, her milk will come out.
We just have to keep the baby fed (bottle supplement) and keep telling her
body that there is a hungry baby (pumping) while we wait.

Anything else we can do?

Pardee Hinson, MPH, IBCLC
Carolinas Lactation Center
Charlotte, NC
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