Pam, I work with many women pumping for premature babies in the NICU. 
What I find is that when they don't pump enough on the first few days, 
or don't pump at all, their milk supplies are limited. Now, these are 
women using hospital grade pumps not nursing the baby. But from your 
history, it certainly sounds like a possible scenario of this mom not 
getting enough breast stimulation in the first days or week. I have 
worked with dozens of mothers who don't get started with any kind of 
pump until day 4-5 and they usually top out at 8-12 ounces each 24 hours 
(from 8 pumpings). A few end up doing ok but the majority do not make a 
full milk supply. I have seen research where the moms who got started 
pumping in the first two days after birth had better milk supplies than 
those who got started later. I think this was in the JHL a few years 
ago. If mom is willing, the care plan you suggested is certainly worth a 
try to see if things improve.
Kathy Eng, BSW, IBCLC

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