And if the mother cannot produce all the milk the baby needs, does that mean
she should not breastfeed?  Even if we have an explanation?  Below is my
"protocol" for not enough milk.

Protocol for “Not Enough Milk”

Here is the way I proceed for "insufficient milk supply" (actually, most
mothers have lots, but the problem is that the baby is not getting the milk
which is available).

1. Get the best latch possible. This needs to be shown by someone who knows
what they are doing. Anyone can look at the baby at the breast and say the
latch is good. The accompanying diagram, or the one available at the second
website below shows how to get a good latch.

2. Know how to know the baby is getting milk (open-->pause-->close type of
sucking). See handout: How to know my baby is getting enough milk at the
websites below.

3. Once the baby is no longer drinking, use compression to increase flow to
the baby. See handout Breast Compression at the websites below.

4. When the baby no longer drinks with compression, switch sides and repeat.
Keep going back and forth until the baby does not drink even with
compression.

5. Try fenugreek and blessed thistle.  These two herbs seem to increase milk
supply and increase rate of milk flow.  There is more information on the
handout Treatments for Problems 2 at the websites below.

6. In the evening when babies often want to be at the breast for long
periods, get help to position the baby so that you can feed lying down. Let
the baby nurse and maybe you will fall asleep. Or rent videos and let the
baby nurse while you watch.

7. It is not always easy to decide if a baby needs supplementation.
Sometimes more rapid growth is necessary. If possible get banked breastmilk
to supplement if you can. If not available, formula may be necessary.
However, sometimes slow but steady growth is acceptable. The main reason to
worry about growth is that good growth is one sign of good health. A baby
who grows well is usually in good health, but this is not necessarily so.
Neither is a baby who grows slowly in poor health, but physicians worry
about a baby who is growing more slowly than average.

8. If it is decided to supplement, the best way is at the breast with a
lactation aid. Introduce the supplement with a nursing supplementer
(lactation aid), not bottle, syringe, cup or finger feeding. See handout on
Lactation Aid at the websites below. Supplement only after steps 3 and 4
above and the baby has nursed on at least both sides.

9. If the baby is older than 3 or 4 months, formula is not necessary and
extra calories can be given to the baby as solid foods. First solids may
include: mashed banana, mashed avocado, mashed potato or sweet potato,
infant cereals, as much as the baby will take, and after the baby has
nursed, if he is hungry.

10. Domperidone is a possibility. It is not a panacea. Check the handout on
Domperidone at the websites below.

http://www.erols.com/cindyrn/drjack0.htm
or
http://www.firstfeast.com/articles/articles.html

Jack Newman, MD, FRCPC
Revised: May 29, 2000

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html