Hi:

A rather long history.  Very anxious mom who is waiting to hear back from me when I told her I would query the wise women on this list.

I have permission to share.  One year ago I worked with a mom who came in for a consult when her baby was 6 weeks old.  At that time, her chief complaint was that her baby had become increasingly unhappy and actually quite angry at breast and she was frustrated with low milk production. 

Mom tells me that she had gone through many weeks of painful and sore nipples.  They cracked and bled and she gritted her teeth throughout feedings and after a while "it got better and didn't hurt so bad."  The first week, she felt baby seemed happy and content at breast, but soon she began supplementing.

By the time she came to see me, baby was receiving half of daily needs through formula from bottle.  She had never pumped.  Baby's behavior at breast was almost painful to watch, as baby would suck on nipple, pop off, suck on nipple, pop off, suck on nipple, pop off..... after a few minutes of this behavior, mom obviously had a let-down as baby stayed for about 3-5 minutes, gulping away.  However, in a few short minutes, baby would only pop on and off, cause mom kept bringing baby to the breast.

Using a hospital grade pump, it became clear to me that mom had a pattern of 5 minutes of good stimulation and nothing, after which the floods would come quick and  plentiful for that short period of time ( about 1  1/2 ounce in a few minutes time) and then nothing, nothing, nothing,  for about another 5 minutes.  Then she would get another ounce quickly and then nothing. 

Mom did this at home for several pumpings in a row and the pattern repeated itself and, of course, explained baby's behavior at breast.  At first consult worked on latch, latch, latch, sent mom home pumping and taking herbs to help increase milk production.   About 5 days later, mom was able to improve latch, but otherwise with little improvement, mom began taking a let-down herbal tincture.  Mom reported several feedings in a row, where she had amazing results.  Said baby had a few good feedings in a row.  Happy to stay at breast for a full feed where she saw him gulping away... consistently,  however, she never saw that day again.  We both don't know why it worked very well and then petered out.  Mom became frustrated, was purchasing a house, etc. etc. and shortly after stopped breastfeeding.

Same mom comes in for a consult, about 1 year later, with new baby who is 3 full days old at visit.  She is observing the beginning of same behavior with new baby., although not as severe as baby is willing to stay at breast for about 2 let-downs.  Again worked on latch, which was about 80% good. Mom proud that she was getting new baby on pretty good and I applauded her for that.  However, new baby has a couple of minutes of non-nutritive sucking, gets a let down and one can see normal wide jaw movements, nice full cheeks and relaxed baby.  Within a few minutes, baby switches to non-nutritive and mostly just "sitting" there.  If she hangs on long enough, mom gets another let down and baby will do her thing for another minute or so and then the pattern repeats itself.  

First time around with first baby,  I was not able to determine if what presented to me was a learned behavior at that point and a low milk supply as a result of breastfeeding behavior.  Mom had been "sort of scheduling, but sort of not.".   She had a labor that was intended to be at the local birth center, but after 15 hours of contractions 5-7 minutes apart and steady at 2 cm., was transferred to hospital where she was pitted and birthed 8 hours later. So, there were quite a few issues.  

This new baby was born at  home after 8 hours of steady labor contractions.  No meds for birth, natural tear that sounds like 3rd degree though and is taking Ibuprofen, prn.  Lochia sounding WNL.  Does not appear to be anything birthwise that would have an impact. Great spouse support. 

This time around though, I can clearly see that this is how her body seems to function.  Got her on a pump and I was not surprised to see her pump expression match baby's behavior.  Baby is only 3 days.  Took 20 cc's at breast and mom pumped another 10 cc's in 15 minutes time.   Took an additional ounce of formula before satiated.

Mom left with instructions to feed first.  When done, pump and bottle.  Take herbal tincture to help increase milk production.  Reviewed all the usual relaxation instructions, skin to skin, etc.  

Any suggestions?  Anyone using oxytocin nasal spray?  


Lori J. Isenstadt, IBCLC

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