At 12:04 AM 5/26/2005, Jennifer Tieman wrote:

>First, when a woman is exclusively pumping, how does supply usually fare?

It drops.

  Is it common to see a decrease in supply despite keeping the
>same pumping schedule?

yes indeedy.

  Is she unlikely to maintain the same supply without increasing
>pumping in the second half of the first year?

It'll be tough, as she's already found out.  There may be ways she can 
improve matters without actually doing more pumping sessions -- by 
following *every single* tip about upping your output, like snuggling the 
baby first (it's excellent that he likes to cuddle up to her breasts), 
massaging the breasts, warm compresses, getting a letdown by hand first, 
altering pumping speeds and suction levels (starting out at fast 
low-suction "flutter suck", switching to slower stronger pattern after the 
milk really gets started, and when it slows down again repeating that 
sequence)....  And maybe she can manage to designate one or two days a week 
for "power pumping" and do two extra sessions, say.
If she can possibly rent a Symphony, that might help?  They are making very 
high claims for its ability to "pump twice as much in half the 
time".  Anyone worked with those yet over the long haul?

>Incidentally, she had trouble with supply with her first child, but always
>felt that was due to poor latch issues in the first 1-2 weeks.  The first
>child was born at home, and my friend had no experienced breastfeeding help.
>  The baby lost nearly 2 lbs after birth (started just over 8 lbs) before she
>realized she was having a problem.

Holy smoke.  But alarming though that history is, it doesn't seem to have 
much to do directly with her current situation (emotionally I am sure it 
feels like a repeat), since this time it's more of a classic slowdown after 
many months of exclusive pumping.  Great story about her mom though.

  This time, though, she initally was
>pumping 32 oz a day or more, so I think at least initially her supply was 
>good.

Yes.  That's well above the 750g (or thereabouts I think) they aim for 
mothers of preemies to reach in the early days to ensure the best possible 
supply while pumping  long-term.  Someone correct me if I'm wrong.

>Second, in the last 1-2 mos, his weight gain has really slowed.  He has been
>physically healthy, but he has gained only a few ounces in the last 2 mos
>He is occasionally supplemented with formula when she is unable to keep up.
>   Despite a lot of effort, she has been unable to increase his daily volume
>much, as he just spits up more if more volume is offered.

Why does he have to eat more and gain more?  He's physically healthy 
--that's key.  He's spitting up when offered more -- why ignore 
that?  Breastfed babies do slow down in their weight gain in the second 
half-year, so in this respect I'd say the kid is right on target.  My 
favorite website for this topic:
http://www.kellymom.com/babyconcerns/growth/growthcharts.html#growth
**If** the shape of this baby's curve is similar to the shape of the 
average breastfed baby's curves in the graphs on this site, and if he is 
growing in length similarly to other babies, and he is healthy, then what's 
the problem?  The "standard" charts, that's what, compounded by the fact 
that obviously this is a sick and vulnerable child who everyone's going to 
worry about.  I assume, for example, that his head circumference is not 
going to match the usual charts.  Though perhaps I'm wrong.
I hear two different things here: (1) sometimes he shows that he needs more 
than she is able to pump, and they supplement with formula; and (2) someone 
wants her to shove more milk into him on a regular basis, regardless of his 
usual signals that he's getting as much as he can handle.  The first is 
reasonable, the second isn't.  (My humble opinion.)
--Elise Morse-Gagne
LLLL, IBCLC
Goose Lane Farm, Swiftwater Village, town of Bath, township of Haverhill, 
New Hampshire, USA

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