I was unfamiliar with this reason, cited below, and attributed to Dr.
Marianne Neifert, as a cause of insufficient milk. This was on the ABC
News web site.
"Inadequate body fat. Lactation uses about 1,000
calories a day, about 500 of which come from body fat
stores. Women who have gained less than 20 pounds
during pregnancy or those with chronic illnesses
resulting in low fat stores may not produce a full milk
supply."
I'd like to discuss this as a cause of insufficient milk supply as I
have a current client whose case I will discuss below. She gave
permission to post this to lactnet.
Her baby first presented to me yesterday after a pediatrician referral
to LC at 10 days with a 16.5 ounce weight loss, this was 3 oz over 10%
of birth weight. Kathy, this referral was my good news for the week.
LC referral prior to initiating supplementation - how wonderful!
A feeding test weight showed about .5 ounce intake over a 40 minute
feed. Normally baby only
feeds about 10 minutes then falls asleep. We managed 40 minutes with
breast compression and mom felt this was a much better than typical
feeding. Baby feeds 10 - 12 times a day. Baby is either crying,
feeding or sleeping at all times, no quiet alert periods. Over last few
days feedings have shortened. No stool in one week. Only 4 - 6 ruins
a day. Great latch and positioning, normal oral anatomy and suckle
action on digital assessment. Neither rythmic bursts of 10 -30 sucks
followed by pauses nor Dr Jacks open, pause, close type suckles were
present. Hand expression revealed drops of white milk.
Obviously we fed the baby, used an SNS, middle sized tubing and eagerly
woke up and ate 2.5 ounces in 15 minutes followed by - eureka!! - quiet
alert period. Care plan was to continue to supplement with SNS, pump and
try fenugreek plus (for reasons that will be obvious below, feed the
mother).
Today, in a phone follow up, baby has had 7 or 8 voids, 2 or 3 stools,
has taken 13 ounces formula via SNS. She will come in for a weight
check tomorrow. Smart baby is quickly learning to flip the areola under
the tongue and suck the straw. Smart mom is demanding a good relatch.
Tomorrow we will decide if it is time to switch to small tubing and/or
cup feed. Mom has managed 2 pumping sessions yielding a total of 2
ounces and will try to do more. She is eating "adequately" although we
did not do feeding log and is taking fenugreek.
Most of this was sad but obvious to me. But.... why did this
happen? Mom had early scabbed nipples. This was by history, well healed
and only tender at start of feeding by visit to my clinic. There
probably was some poor latch history but I think it was brief and well
corrected. Mom is very well read and
attended LLL meetings the last 6 months of pregnancy. She had good
information and good early lactation
management.
############################# ???RED FLAG????
BUT, she had no breast growth during pregnancy and NO WEIGHT GAIN
AT ALL DURING PREGNANCY, also, she has lost 21 pounds in the 10 days
since birth.
#############################
She had diet managed gestational diabetes and kept her sugars well
controlled. She is not however anorexic or extremely thin. I
calculated her BMI (body mass index) using
www.loop.com/~bkrentzman/obesity/bmi1.html and I figure her to be about
a 21 BMI (low normal range), down from a 24 BMI (high normal range)
prior to this (her first) pregnancy.
MY QUESTIONS:
1) Have any of you experienced insufficient milk with poor weight gain
during pregnancy or insufficient body fat as your main educated guess as
to cause?
2) Has Dr Neifert published the information quoted at top of my email? I
don't remember seeing this as a cause of insufficient milk anywhere else
except in this web article quoted above.
Thank you,
---
Carla D'Anna, RN, IBCLC hospital based LC
from Maryland, just north of Washington, DC
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