Dear Lactnetters,
I've had a few weeks of interesting cases. This one I originally thought
was "solved", but there always seems to be something additional. It started
off with a baby first seen at 5 weeks of age. B/W 6lbs .5oz -- wt at 5 wks:
7lbs 15oz. Issue: painful latch. That seemed to be taken care of. Weight
gain was over 1oz per day. Mother said that pain was soooo much less, but
latching was still painful because baby kept pulling back and clamping.
Watched feeding again and this time noticed baby sputtering and milk running
out of sides of mouth as baby pulled back. Ok, so an overactive let down.
As baby came off, milk sprayed across office!!! We discussed positional
changes to lessen that. That seemed to help somewhat, but still didn't
solve the clamping. My next thought is that she might have an oversupply.
She tends to believe her supply is not much, rather than *too* much, but she
was willing to try nursing on one side at a time for 6-8 hours and see what
happened. After 2 days of that (still using anti or neutral gravity
positions) and a 3rd day of once side at each feeding, the baby had only
gained a little over 2 oz. Mother states that baby seems more settled, but
still clamps and pulls back and mother has noticed in the last day (when she
was alternating sides) that even with the anti-gravity position (i.e. lying
on back) her milk was shooting up out of the nipple like a fountain.
I'd say oversupply, but I worry that weight gain slowed down when she tried
to lower supply. I'm I overthinking this?
Also, mother is taking Synthroid, and also plans to get her levels
checked... but... I've never heard of thyroid problems causing
overproduction??? Hypothyroid may inhibit milk production, but hyperthyroid
doesn't cause overproduction, does it???
Any thoughts on this case? Might this be a case where mother just has a
forceful let-down and should hand-express until the first let-down and when
that subsides put the baby on? Hard to do that when you are out and about.
Should she just expect to carry cloths around to catch the milk of that
first let-down?
I'd really appreciate any suggestions. It's weeks like these that really
slam home how much I *don't* know!
Regards,
Cindi Swisher, RN, IBCLC
Colorado Springs, CO
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