I'm taking care of a mother and baby now 6 days post birth. Baby was born
after a long, difficult labor by vacuum assistance. Mom had an epidural
during labor, also. Mom is 35, this is her second baby, first was born 15
years ago by c-section and was breastfed for a few months. Mom reports she
had plenty of milk for that baby, and no problems with supply. Mom was
significantly anemic at the start of labor, and left the hospital with a
hemoglobin of 6.9, although she didn't really have much bleeding at delivery
or after. This baby went to breast in the delivery room, and appeared to
nurse well in the hospital. She latches well, and sucks avidly and she
received no supplements, bottles, or pacifier in the hospital. Baby weighed
8 lbs 14 oz at birth, and 8 lbs 4 oz at discharge at 48 hours of life. Mom
decided on day 4 that baby did not seem satisfied after most feeds, was more
frantic at breast and she started to offer some formula by bottle after
feeds were baby seemed unsatisfied. Baby has ad since then on average 6-8
oz of formula a day. Mom still does not feel that her milk has come in,
does not feel full, does not notice a letdown. She has tried to hand
express some milk and gets just clear drops. Baby weighed 8 lbs 6 oz today,
4 days after discharge (2 oz gain in 4 days.) Mom continues to offer the
breast whenever baby is interested, which is at least every 2 hours. My
question, where is this mom's milk? Is the anemia contributing? Would
fenugreek or Reglan help here yet?
Mom left my office to go get a pump, and will start pumping, continuing to
offer the breast, and supplementing. We will be in close contact also.
She's not eligible for WIC, so cannot see the IBCLC there unfortunately.
Jennifer Tieman
Family Physician
Mom to 4, including nursling Caroline Rose born 5/31/03
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