I have encountered this exact situation, a number of times, in fact. The
conclusion I've come to is not too helpful: It Happens, and I don't know
why. But the unscientific conclusion I've reached is that by the time baby
#6 or ++ comes along, mom's tired, maybe stressed, almost certainly
time-deprived, and therefore maybe less quick to respond to early or subtle
cues, and maybe not taking the time to really replenish herself the way
you'd like to see her do (i.e. eat & drink). And sometimes these women are
on the "older" side - not that that *should* be a factor, theoretically, but
in my experience it may be. (Now I know, there are many of you out there who
have successfully nursed 6 or more children without problems - please don't
misunderstand me; NOT saying that's the cause, just describing what I've
seen.)

Most of the women I've worked with in this situation have either been very
low-income, and therefore coping with all the additional stresses that that
brings in our society (including, in the US, being viewed commonly as either
a moron or "irresponsible" if you have a large family and not a lot of
money), and/or over 42 or so. Does this mom smoke? Take in a lot of
caffeine? Are the kids pretty closely spaced, or, alternatively, has it been
15 years since her last baby? Is the mother very thin, the kind you might
describe as being "worn to the bone"? Is she a "worrier"? All of these
things have been factors in the situations I've worked with - usually
*several* going on at once.

One thing I'd say for sure - when an experienced BFing mother like this
tells you there's "not enough milk", and your observation of the baby bears
that out, TRUST her perception!

What to do? #1 Feed the baby. It's important to find out to what lengths
this mother is willing/able to go, because no matter what you think she
"should" do, she's the one who will have to do it, and she's the one who
knows what will work (or not) within her family. So maybe an SNS, almost
certainly more skin-to-skin time, all the usual recs to get mom & baby
together. But you need to work very collaboratively w/the mother, because
this is no rookie mom here!

And I would ask her if she "feels" that there's something not-quite-right
with this baby, too. One woman I worked with in this situation, who was a BF
fanatic in the best sense of the word and one of my Peer Counselors at WIC,
turned out to have a baby with cystic fibrosis that she just couldn't get
settled BFing - she had successfully nursed 7 previous children (including a
previous child w/CF). She smoked like a chimney, lived on caffeine,
cigarettes, & beer, weighed 87 pounds, was in her late 30s but looked like
she was 55, was beaten by her husband, had been sexually abused and suffered
incest and rape since her own girlhood, was raising children with multiple
physical anomalies, and had multiple medical problems herself, but had just
kept chugging along BFing throughout it all. She *knew* when the baby
"wasn't getting anything", she knew something was wrong, and of course she
was right. (And eventually she got this baby going at breast too, though
never exclusively and only by using every trick we could come up with. I was
absolutely blown away by this little woman!)

Cathy Bargar RN IBCLC

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