Happy Holidays to all as you read my first solo message to Lactnet!  One of my
wishes has come true now that I'm actually FINALLY in the 21st century with
the computer e-mail capability.
I'm sending greetings to many 'netters who will remember me from my 2 years as
VP on the ILCA board, and as a long time LLLeader from W. NY (Buffalo) and W.
PA (Pittsburgh, Mt Lebanon and Bethel Park groups Hello!).  I have been IBCLC
since the 2nd year the boards were given (sat it San Diego) and in home based
private practice before starting my business, Maternal Expressions, with Co-
Owner Dianne Neilson, RN IBCLC in Folsom, California.  To Mommilk, send me
private e-mail and we'll chat.  There are several stores in the US and a group
of retailers that meet every year at the ILCA conference to share and network.
The store is in its third year now and very successful.   We do personal
consults, sell/rent Medela, maternity apparel and lingerie. Its a fun place to
be and a lot of work for the owners.

Now to the question of the day for me....I am helping a P1G1 33 yo who
presented on day 8 post pardum c/o very low milk supply.  Hx of same with #1
child now 2years old.  She is IDDM since puberty, had a vag del with epidural
and otherwise uncomplicated. Her breasts are slightly asymetrical with the
left looking long and tublar, there is a wide separation between the breasts,
more than 3 finger widths. she indicated that she feels MER, denies surgery or
fibrocystic breasts. Nipples normal.  She reports slight feelings of
lactogenesis, fullness, on day 4, no leaking. Baby was bf in incorrect
position with faulty latch - Mom not supporting breast and baby shallow on
nipple only in cradle pos.  Fixed pos/latch easily and baby
is now a  champion nurser, She was born at 41 wks gest at 9#3 and was 8#15.7
in diaper only on my baby weigh scale.  Baby was supl with 2 oz AMB via
playtex nurser nipple.
After fixing position a latch, I sug. Mom switch to Avent slow flow to assist
bb with wide open mouth, pump after bf 8x/d for 10 to 15 minutes, support
breast during entire feeding with compressions and take herbs to stim
production.  She did all that returned in 3 days to report slight increase in
milk volume - 3 oz per day, up to 3 and a Half oz per day.  She feels sligntly
fuller, baby is nursing very happily and took very well to Avent teats.  On wt
check, baby drank 18 cc combined both sides in 20 minutes than drank 2 oz from
bottle.
Assessment:  Low volume of glandular tissue.
The question is:  How to maintain this small supply as long as possible.  Mom
is willing to pump after bfd as many times as necessary...but wonders how many
times is really needed, and if its necessary at all with baby nsg so well.
SNS is out, she tried it several times and just found it too cumbersom.
My hunch is there is no need to pump at all since bb is doing the job well and
cont with herbs since she likes them and they seem to help.
What does the collective wisdom of Lactnet think?
TIA.
Love to all,
Karen Evon, IBCLC
Sacramento, CA USA