Jaye,
My thoughts:

Poor little babe. Not only is bodywork THE priority for him, look at her experience! Find someone who can adjust her palate. The hypothalamus sits just above the palate. If the palate is rigid, it is not allowing proper stimulation of the hypothalamus/pituitary complex. Perhaps dopamine is still inhibiting prolactin. or at least inhibiting its secretion.

Also, consider oxytocin. Some of the ways I look for this as potential problem: when mom adds a new galactogogue, does she get engorged for a little while? How effective were her contractions? What is her experience of reaching orgasm? If there is indication of inhibited oxytocin, then I start with Bach Flowers and EFT and will suggest syntocinon if they are not effective. This is certainly a case where I would use Bach Flowers, regardless of oxytocin issues.

I also noted that mom was pumping infrequently, yet it appears baby's latch is inefficient. That alone could be the cause of low supply and mom would have to pump more frequently or use a supplementer at breast--which is very easy to do with a shield. 

If you suspect hypoplasia, use goat's rue. She can always use domperidone. I also would not rule out retained placenta b/c of the cesarean or the prolactin levels. 

Also, when I want to build supply, I build the mom's nutritional profile--esp with phytonutrients and EFAs. 

Jennifer Tow, IBCLC, CT, USA
Intuitive Parenting Network LLC

 



"Baby born 12-15-08 by emergency c-section.  32 hours of labor 4 hours of 
pushing and then they discovered baby's head was off to the side and sunny 
side up.  She had a 7 hr walking epidural.  Baby was 41 wks gest."
 
Mom had been pumping sporadically but was only getting 10-22mls per side
when she had had 3 hours in between feeds.  (she was taking breaks to simply
feed the baby and get some rest)  I told mom to pump and feed the baby -
let's get the supply up since it was so low and I suspected it could be
because of mismanagement in hosp as well as possible suck issue with baby.
Pumping was hurting so recommended she get larger flanges.  

I saw mom today (1-7-09).  She has been taking More Milk Plus - no results.
She pumps 8-10 times in 24 hours - she gets ONLY 10-22 mls per side.  I did
a visual exam - there is at least 5 inches between her breasts - but
otherwise they look perfectly normal - perky and rounded, quite beautiful
actually - she has the perfect breasts for BF (which is why I don't
understand why she was handed a nipple shield.).  Her mother was unable to
produce enough milk for either of her 2 children (but was able to produce a
bit more with baby #2) so there seems to be a possible family history here.
I did a suck eval on the baby - he has some issues - very disorganized,
chompy, tongue all over the place and some real suck/swallow/breathe issues.
I taught mom very carefully paced feeding technique as baby was inducing
apnea by forgetting to breathe.  His body is curved and out of alignment and
I have referred them to my Practioner for further evaluation.  I suspect his
issues are the result of birth trauma and should be fixable with treatment.

 But what of Mom and her milk supply?  She was unable to get a prolactin
level test until day 18 - but her level was very high - 161.  Her thyroid
was also in good shape.  So what is the deal here?  What am I missing or am
I?  Why would she have great prolactin levels and breasts that look perfect
(aside from the wide spacing) and have very little milk?  Am I looking at
hypoplasia?  There is no history of any other hormonal issues for her.  She
had minimal breast changes during pregnancy.  This is a really frustrating
thing for me to admit - but I am NOT a hands on type of LC and so don't
really know how to palpate the breast to feel for glandular tissue.  I
rarely have the need to feel something going on in a moms breast and when I
do it is very obvious (like a plugged duct or abscess both of which I have
found easily).  

I suspect that she has hypoplasia and that the supply was compromised to at
least some degree - but it is that high prolactin level that has me stymied.
I thought about retained placenta but then the prolactin wouldn't be that
high.  Thoughts?  

 



 


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