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Subject:
From:
Pamela Mazzella Di Bosco <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Thu, 9 Feb 2006 09:15:12 EST
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I must be on a low milk supply trend this month.  I am used to things  in 
threes, and was hoping I would be dealing with the threes with the same  causes 
too for ease of problem solving.  But, I am instead getting to have  threes 
with three different causes! 

What impact would being a gymnast as  a young woman have on later milk 
production capability?  This mom did not  have her first menstrual cycle until late 
in her 15th year, and then they were  always irregular and sometimes only came 
every few months and did not last  long.  She used to bind her breasts tight 
to appear to have none.   They were not that large to begin with.  During her 
pregnancy, she did not  need a larger cup size, though they did appear a bit 
larger and her areola  darkened.  She gave birth via emergency c-section with 
general anesthesia  due to pre-eclampsia at 36 weeks.  She pumped, but in the 
early days she  was mostly out of it and unable to do much.  Her baby was in 
NICU and she  pumped only a few times a day.  (Don't know why she missed the 
part about  pumping more often, because I know where she delivered is extremely  
breastfeeding supportive.)  When she was with the baby, she  breastfed.  Her 
baby came home, she had sore nipples.  We fixed the  latch.  At the time, the 
baby's weight was fine.  Intake for the age  and size of the baby was also 
fine.  However, now the baby is 7 weeks old,  and mom is concerned because the 
weight gain is slow and the idea to give  formula has been mentioned more than 
once.  She 'feels' her breasts are not  producing enough.  The baby beats her 
chest and cries at the breast within  a few minutes of feeding, mom can only 
express with a hospital grade pump less  than an ounce and there are never any 
'streams' only drips of milk.  She  finally started supplementing with formula 
because the baby was truly unhappy  and her breasts felt completely empty.
 
When she came to me this time, the baby was able to get 54 ml combined from  
both breasts after more than 2 hours since last feeding at the breast, but  it 
took more than 30 minutes, lots of breast compression and a very not  happy 
baby.  An hour and a half later baby only took 8 ml from one side and  2 from 
the other and was extremely agitated and showed obvious signs of  hunger.  Mom 
not able to express even a few drops.  
 
Mom's blood work all came back normal. When I get these clients with low  
milk supplies I am starting to "hope" for thyroid issues so there is at least a  
reason and then when we don't have an easy reason, I am frustrated for the 
moms  because it also means no easy fix.
 
Plan is:  feed the baby at the breast as she is already doing, but to  go 
ahead and continue with the supplementing as she is doing (she is not giving  
much formula, but it is enough to have allowed the baby to have some happy  
content times) and lets wait and see what happens.  She is going to use an  SNS.  
Since the baby is so unhappy with the flow, I am hoping with a little  more 
flow the baby will be happier to suck more than a few minutes and mom won't  have 
to be nursing, pumping, feeding, etc. She is going to have an ultrasound  
done next just in case there is a reason why her breasts just feel so flat and  
empty.  Even after the she has had a few hours of rest, she still does not  
feel full and the most she has ever been able to express even when she first  
wakes up is less than an ounce from each breast.  She is already taking  herbal 
galactagogues and is reading more about pharmaceutical options.  She  is very 
well informed and is willing to do whatever it takes to be sure her baby  is 
breastfed, and supplementing is very heartbreaking for her.  
 
I know we have discussed before that the idea insufficient glandular tissue  
should be rare, but is it really rare?  Or is it that in the past not many  
women were breastfeeding so it was rarely seen, but now as the numbers are  
increasing we are going to see it more frequently?  I know I can definitely  
'feel' the difference in breasts that are full and making a lot of milk and  those 
that seem to only barely dribble and moms are working like crazy to keep  the 
supply capable of making at a maximum.  
 
Anything else she can try?  I just want to cry with these moms who are  
wanting to breastfeed, who know it matters, and have to struggle just to do what  
so many others take for granted and others don't even bother to try.
 
Thanks,
Pam MazzellaDiBosco, IBCLC, RLC
 

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