i have been following the threads with great interest. i went and saw the
mom i posted about last week, who had had problems with milk supply with
her first baby, and appears to be having problems with her second (1 week
pp). mom reported a little fullness, warmth and lumpiness, but no
discomfort or leaking at 3 days pp when her milk "came in". i palpated and
observed none of the usual turgidity/fullness i am accustomed to for a 1
week pp mom, but her breasts appear normal, smallish (changed from A to B
cup), normal graspable nipple, small areaola. digital oral exam on baby
revealed what appears to me to be normal tongue, palate, and suck. baby
has slightly shallow latch, but not atrocious, mom not sore anymore, though
was at first (no trauma though). baby nurses 2-3 minutes then falls asleep
if not being supplemented at breast, a bit longer if supplemented, and
takes about 20 ml of supplement at breast before falling asleep. baby
appears to be taking about 50% of calories from supplement, but next wt.
chk. tomorrow shoudl reveal the accuracy of this estimate. we tried
pumping one side while nursing the other, and got no more than mom usually
gets double pumping (a couple mls). breast compressions, switch nursing,
etc. don't seem to help much. left mom with plan to achieve active nursing
(by supplmenting at breast) or pumping to total 150 minutes/24 hrs, mom
taking fenugreek capsules already to no imporvement, and hs decided to
start domperidone (started yesterday). had a blood draw and thyroid is
smack in the middle of normal range, but will get results on other hormones
tomorrow or tuesday. so:
in light of the discussion about early and often to reduce engorgement (and
i have not seen any answers to someone's question re: *why* that would help
given that Lactogenesis II occurs regardless of stimulation (endocrine
control), is there a consensus about whether we should expect that a mom of
a sleepy, ineffectively nursing baby might have a sluggish supply from
moment one of lact. II, or are we more likely to see obvious signs of
ineffective milk removal, such as engorgement, discomfort, and leaking,
followed later by suppressed supply due to feedback inhibitor/cell
apoptosis, etc?
i am grappling with trying to understand this all right now, and i
completely agree with the recent statement that causes of multiple, complex
and interrelated for almost any phenomenon we are trying to tease
apart. i apologize if my question is too basic - i am trying to
understand whether lack of extreme obvious signs of lactogenesis II, since
baby wasn't effectively nursing well from day 1 (sleepy) should be a red
flag for a primary milk supply problem, or if the milk supply issues could
have simply been a result of innefective suckling, even though no severe
engorgement, etc., occured. how many of the moms who choose not to
breastfeed and never put baby to breast never experience severe
engorgement, leaking, and discomfort? perhaps this would be a good way to
study the issue, except those aren't the moms i work with .. . anyone?
thanks
Lyla Wolfenstein
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