Hello Everyone,

I've been reading the archives but would like to post this situation  
anyway...

Helping a second time mom with 18 day old baby.
Baby weighed 7 lbs 14 oz at birth born at home- no complications...
Lowest recorded weight was 7 lbs 5 oz on day 3.
Highest recorded weight was 7 lbs 15 oz (mom recalls this as being on  
day 6).
Today baby weighed 7 lbs 11 oz.

Mom did not notice increase in breast size during either pregnancy  
but did have darkening of
areolae. Mom had retained placenta with first baby. She felt that  
supplementation led to downward
spiral in supply that she never recovered from, even after placenta  
was removed. She purchased a
Pump in Style, she took fenugreek and nettle (among other herbs which  
she can't recall now) and
used an SNS in an attempt to save breastfeeding. (She did NOT have a  
blood transfusion and does
not feel she lost a lot of blood in association with the retained  
placenta)

After this birth she experienced slight breast fullness in the early  
days of breastfeeding, but
nothing she would describe as dramatic or uncomfortable. She has  
small but symmetrical breasts.
I would describe them as completely normal for a slender non- 
lactating woman. They seem flaccid
like close-to-weaning or non-lactating breasts. She can squeeze milk  
from them but never sees
milk leaking from the other breast when she is nursing. She only  
hears audible swallowing from
the baby during night nursings. She sleeps with the baby and cue  
feeds. The baby is never happy
off the breast any time during the day, but will sleep an hour or two  
off the breast after a night
nursing with copious audible swallowing.

The baby is very thin but latches beatifully and nurses vigorously at  
first. The mother's nipples are
not damaged or sore.

After nursing from both breasts and for about 40 minutes and to sleep  
the baby had consumed
just 2/10 of an ounce. The mother reports when she pumps after  
nursing she can only pump
enough to cover the bottoms of the collection bottles. The mother  
describes the stools as watery
but frequent 6-10 times a day.

She is a vegan, and daughter of a vegetarian- her mother came with  
her to the consult. They
impressed me as knowledgable and motivated so I'm inclined to think  
B-!2 deficiency is not the
culprit. However she does consume a lot of soy and I wonder about the  
role phyto-estrogens
might be playing in her difficulty. I have asked her to replace the  
soy she consumes with other
protein sources for the time being.

  Do vegans need to consume a lot more food than non-vegans inorder  
to absorb all the nutrients
they need out of their food? (I'm thinking about whether or not fiber  
or phytates can alter the
bioavailabiluty of nutrients...) She kept a diet diary in conjunction  
with her Bradley class and her
highest recorded protien intake in one day was 90 grams.

The mother's mother has a thyroid with only one functioning lobe.  
When she was younger this
presented to no problem for her...she conceived and breastfed her  
children with no trouble...but
she has needed thyroid replacement in recent years.

I sent her home with a scale. She is planning to nurse and then  
supplement on as needed basis
according to the test weighings...I am hoping night nursings might  
not require supplementation.
Whenever a nursing requires supplementation she is going to pump  
while the baby is digesting
the formula supplement. Her experience with supplementing at the  
breast with her first child was
not a positive one, but I sent her home with an SNS in case she  
decides she wants to use it.

Any input would be greatly appreciated.

Jennifer O'Quinn
IBCLC



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