"the milk was watery" when? At the start of a feeding? After a feeding? 
After/during a pumping when she finally resumed breast emptying?

Watery milk at the end of a feeding or pumping means poor breast 
emptying. That combined with a baby who has downregulated his suction 
pressure to avoid being drowned can be very problematic.

This is a situation where I would want to have good pre and post feeding 
weights and a stethoscope to listen to the baby's swallowing and 
breathing. Sometimes mom is saying baby is no longer gulping and 
drowning, so she thinks he's getting nothing. Letting her hear normal 
gentle swallows can reassure her if warranted.

If the milk supply is really low, supplementing at the breast can be 
most helpful, because babies work more diligently if there is flow.

Catherine Watson Genna BS, IBCLC  NYC  cwgenna.com

On 12/2/2013 5:24 PM, Lisa Paul wrote:
> I have PTP.
> Excuse my approximations, I was not planning to post this and I had an idea on my drive home so all my notes are at the office.
>
> Baby is about 2 1/2 months old today, weighs 16lbs.  (birth wt over 8 lbs) Baby has acid reflux.
>
> Mom is in her early 30's, and this is her third child.  She BF the 2nd child for close to year, I believe.  Has been exclusively BF up until 2 weeks ago.  At that time she had a tubal, did not pump or extract milk for 12-24 hours.  She said that when she did go back to BF, the milk was watery.  She continued trying to BF, but her milk dried up.  She has tried to hand express and nothing comes out.  She continues to let baby nurse at the breast, but baby is not getting any milk, and she hears no swallows.  Mom also takes non-estrogen birth control for control of heavy menstrual bleeding.
>
> I encouraged her to continue with allowing baby to suckle at the breast.  I suggested that she follow up with her MD for thyroid testing, potential galactogogues, and prolactin levels.
>
> But something continues to niggle at me about this.  Why did her milk dry up so quickly?  Then it hit me that the 8 lbs of weight gain in the first 2 months probably meant that her milk was pouring out of her breast without any real effort from the baby.  If that is the case, baby may not know how to extract milk but is used to passively drinking?  Would that coupled with a brief break in BF cause this cascade of events?
>
> M would like relactate, but I am not sure what to tell her to do to make that happen.  She does not own a pump, but I would be able to provide her with one if that would be useful.
>
> I appreciate your input!
>
> Lisa
>
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