Dear LactNetters,

I would really appreciate any thoughts on strategies to help this Mom’s milk supply.  I’ve been in touch with Mom via email and phone as a LLL Leader.   I’ve wondered if the progesterone to stop preterm labor administered through 35 weeks could have delayed her milk supply increasing.  Mom was induced at 36 weeks.   Permission to post.

Thanks!

Ellen Rubin, MA, IBCLC, LLLL

This was the story yesterday:
> Mom very motivated to nurse baby
> G2P2L1
>  First pregnancy resulted in preterm labor and birth due to an infection around 27 weeks.  Baby did not survive.  Mom’s milk came in and she was focused on stopping supply
>  Mom describes herself as overweight, no PCOS, no thyroid issues, no identified infertility - took 9 months to conceive one of her pregnancies.
> With most recent pregnancy mother was given P17 (progesterone) to prevent preterm labor because of first pregnancy.  The last dose occurred at 35 weeks.
> induced at 36 weeks due to preeclampsia, birth weight 5 lbs. 6 oz, healthy, Mom still taking blood pressure meds now, but lower dose
> due to birth weight, glucose tested every 3 hours and once came “close to danger zone”.  Mom was told to choose between NICU or formula and she chose the latter, with no subsequent blood sugar issues
> pedi encouraged formula “until milk comes in”, they did so
> discharged at “normal time”, with weight of 4 pounds 14.5 ounces
> at home, woke baby every 3 hours, worked to get her on each breast for 15 minutes, followed by 10-20 mL formula if parents felt she was not feeding well at the breast, pumping with a Limerick 10-15 minutes after every feed
> day after discharge weight was 5 lbs. (Aug. 26)
> supplementing only when judged “bad eating session”
> weight at 5 lb 2 oz (Aug. 30)
> feeds improving, eliminated formula, reduced pumping
> weight still at 5 lb 2 oz on Sept. 2, 8+ wet diapers, one large stool daily
> advised to offer 1 ounce formula after each feeding session, parents obeyed, baby began to seem less interested in breast
> pumping after almost every nursing session with Limerick with less than one ounce total yield per pumping session, started Fenugreek
> obtained SNS, used at every feeding, stressful for parents
> Sept. 6:  5 lb 8 oz (two weeks old), pedi happy, advises to continue feeding strategy (= feeding at breast + SNS + pumping)
> pumping output diminishing, averaging 10 mL total per pumping session with range of 5 – 25 mL
> met with IBCLC, told baby was a lazy eater, advised breast compressions, latch proclaimed good, told to keep active on first breast for 15 minutes, and supplement either with SNS or bottle.  Second breast, optional.
> was advised to switch from Limerick pump to Symphony
> continues to pump after every feed, now obtaining even less = 5 mL after 15-20 minutes of pumping.  Mom feels horrible each time she pumps (after almost all feeds)
> continues to nurse every 3 hours or sooner if baby indicates, taking fenugreek, staying hydrated
> Mom feels “devastated” 

Sept. 8:  This is when I spoke with Mom and couldn’t think of any new strategies to help her.  She asked if this was hopeless, told me how badly she wants to nurse this baby, but is worried her milk supply is a lost cause.  Given the ability to pump 1 ounce initially, I encouraged her to set a time (perhaps one week from now), continue to pump and then re-evaluate.  I suggested trying the Limerick again.  Tried to offer lots of empathy - we spoke almost one hour, picking through her story.

Mom emailed me an hour later saying she fed baby with SNS on one side (took ½ ounce) and rather than putting her to second side, Dad gave 1 ounce bottle and Mom double pumped with Limerick and obtained 35 mL  (wish I could take credit for that).  20 mL came from the “second side” which is usually her lower producer.

Sept. 9:  Mother emailed to say she pumped instead of nursing at first morning feed and obtained 65 mL – the most she’s ever gotten.  Was also prescribed Reglen today and took her first dose.  Mom is cautiously optimistic, and reading “Making More Milk”

Weight summary:
Aug. 23:  5 lb 6 oz (Birth)
Aug. 25:  4 lb 14.5 oz (Discharge)
Aug. 26:  5 lb
Aug. 30:  5 lb 2 oz
Sept. 2:  5 lb 2 oz
Sept. 6:  5 lb 8 oz (two weeks old)

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome