I saw this dyad again today, which is Day 12 postpartum, and the baby
has gained well on mostly formula over the last week -- she went from
4 lb 15 oz to 5 lb 6 oz in the last 8 days (birthweight was 5 lb 4
oz). Mom has been breastfeeding first, with breast compressions, and
then bottle-feeding about 1.5-2 oz around the clock every 3 hours.
She has given up on pumping due to fatigue, lack of time, and wanting
to have baby at breast more. Baby breastfed about 15 minutes with
breast compressions on one breast, and the scale showed NO milk
transfer whatsoever. (Possibly there was less than 0.1 oz
transferred, which the scale cannot measure.) The latch looked
really excellent to me; Mom has no nipple damage, and the nipple is
nice and round when it comes out of baby's mouth. Suction strength
seems normal -- there is resistance if you try to pull the breast
away from her mouth. We pumped during the consult and got a few
milliliters. She is starting on More Milk Plus (fenugreek, blessed
thistle, and fennel) today. She indicated that she is definitely
opposed to taking domperidone.
Her bloodwork came back that she is anemic and has high platelets. I
had recommended that she get her prolactin and thyroid levels
checked, but she is not able to do that at the present time because
of an issue with her insurance company.
I demonstrated an at-breast supplementer a la Jack Newman, and she
loved it, so I left her with 10 #5 french tubes and instructions for
ordering a lact-aid. We estimated that baby took 4 ml of breastmilk
while using the supplementer!
She wants to see me again next week. She indicated that her goal is
to give her baby whatever amount of breastmilk she is able to
produce, for as long as she is able to.
I am very discouraged that she is working so hard for so little
results, and I wish I had a breastfeeding medicine specialist to
refer her to so that we could learn why her milk production is
basically nonexistent.
I appreciate so much all of the great ideas I have gotten from
Lactnet! I will post an update if anything changes or I learn
anything new.
Sincerely,
Lynnette Hafken, MA, LLLL, IBCLC
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