I thought I'd share my story with you all, and for the archives.  I  
am a LLL Leader and IBCLC.  I nursed both of my two previous babies  
for over 2 years with no major issues.  I have no risk factors for  
low milk production (well, I am overweight, but that is nothing  
new!).  No thyroid issues, no fertility issues, no breast/chest  
surgery or injury, no issues with my menstrual cycle, no hypoplasia,  
and no history of lactation failure.  I had a normal healthy  
pregnancy with baby #3, which culminated in a beautiful natural  
delivery in a birth center at 37 weeks gestation (I do tend to  
deliver early; my other babies were 35 weeks and 36.5 weeks,  
respectively).  We had immediate, continuous skin-to-skin with no  
separation or supplementation of any kind.  We breastfed as soon as  
she started looking for my breast, within the first hour.  She seemed  
to have a great suck, normal oral-motor function, and was swallowing  
audibly from Day 1.  I did however have painful nursing on my right  
side, and quickly developed a compression stripe, much to my  
embarrassment as an IBCLC!

I went on my merry way, until Day 3 when I noticed no signs of  
Lactogenesis II either in my breasts or in my baby's stooling.  In  
fact, she passed the meconium on Days 1 and 2, and then there was  
nothing.  She continued to have wet diapers with clear urine in  
reasonable amounts, so she was staying hydrated.  On Day 3 we went to  
the pediatrician, and she had lost just a hair under 10%, but the ped  
was supportive of waiting to start supplementation since she was  
staying hydrated and I have a scale at home.  On Day 4, she still had  
had no stools, was still wetting normally, and had lost another  
ounce.  The ped wanted us to start supplementing.  I said I would  
think about it.  Test weights were about 0.8 oz (20 ml) milk transfer  
on my left breast and nothing on my right breast.  (I was also  
compressing the heck out of my breasts during the feedings and paying  
careful attention to latch and to her rate of swallowing.)  I called  
my IBCLC friend in a panic and she stressed how important early  
stimulation is, and said I should pump after every feeding (duh, but  
I was still in denial that I could possibly be having milk production  
problems, so I am so glad she emphasized the importance of faithfully  
pumping 8 times/day after breastfeeding.)  Pumping yielded 5-15 ml on  
the left breast, and just a few tiny drops on the right.  Hand  
expression was no better.

My baby was starting to act hungry and unsatisfied after constant  
breastfeeding, so I broke down and gave hydrolyzed formula by  
periodontal syringe at breast.  The next day (Day 5), she had 3  
stools.  On Day 5, I would get about 15-30 ml pumping my left breast,  
and drops to 5 ml on my right breast.  By Day 7, I was able to  
produce enough on my left breast to cut out the formula and  
supplement with breastmilk, but I was still getting only about 10 ml  
every time I pumped my right breast (I did not nurse on that side  
except maybe once a day, because it was so painful.  The breast  
tissue was much less elastic on that side).  I started supplementing  
with bottles, because my baby did not draw milk through the SNS well,  
and I wanted to feed her efficiently so I could have enough time to  
pump and spend time loving my baby and my older children.  When my  
baby would nurse on a "full" breast, she would still get around 20-30  
ml, because the flow was so slow it put her to sleep.  With the  
bottle, I could make sure she got enough in a reasonable amount of  
time.  It wasn't until Day 9 that I confirmed that she could get 60  
ml by breastfeeding.  I was not able to cut out the bottles  
completely until Day 15.

During this whole time, I was not having symptoms of retained  
placenta, and blood tests showed pretty normal prolactin, thyroid,  
testosterone, and HCG levels.  I was not under extreme stress, except  
the normal stress of adding baby #3 and being worried about my milk  
production.  I started More Milk Plus and lecithin just to be on the  
safe side on Day 4.

My baby is now 1 month old, and we are exclusively breastfeeding, and  
still only on the left side.  The most milk I have ever gotten from  
the right has been 40 ml, and that is after sleeping 8 hours with no  
pumping or breastfeeding on that side.   I plan to see a breast  
surgeon to ask to have some imaging done, and possibly an  
endocrinologist to look for subtle hormonal issues, but I have a  
feeling that this is going to remain a mystery.

I have renewed respect for mothers who overcome much more difficult  
situations than the one I faced, and compassion for mothers who  
choose to spend more time with their babies and less with their  
pumps.  I also have renewed fervor for helping mothers nurse their  
babies.  It is really, really important work we are doing.

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