Well, the mother I wrote about on 9/8 never did get more of a milk supply.  She
didn't go all out to do everything that might have given her a little more, but
after seeing her again at 19 days PP my best guess is insufficient glandular
tissue.  She was not interested in using the SNS; we'd used the starter SNS
during the time baby was hospitalized and she didn't wish to continue; she also
never filled the prescription for metoclopramide.

Linda Smith's point about "milk removal not stimulation" was well taken--I
*will* be more careful about my wording in the future!  Baby appeared to be
suckling effectively when I saw him at the breast at one day of age; as soon as
baby was admitted on day 5 mom began pumping after feeds with a big electric
pump and continued the pumping q3h for about 5 days without seeing an increase.
She remembers a change in her breasts at 3-4 days PP, described feeling a
"lump."  When I palpated her breasts on day 6, they were primarily soft with
only a small area in each that felt firm; on day 19 they felt essentially the
same.  (There is more firm tissue in my definitely dried-up "old boobs"!)  The
report I was given about her age was incorrect; she's only 32, not 38 as I
originally thought.

Surprisingly, baby is still willing to latch on and nurse for about 10 minutes
each side before the bottle is given (for a grand total of 6cc during this last
visit).  Mom is going back to work in 3 more weeks, so will continue as is for
as long as baby is willing.

Thanks to Jan B. and Linda for their input.

Becky Krumwiede, RN, IBCLC, Wisconsin
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