Hi friends and colleagues,
I am working with a beloved family member, PTP who is struggling with low supply. My request for help from all of you comes from that place that I am not sure I am being completely objective, am forgetting something, but also I am seeing an unusual pattern I think.
Baby also has some issues with swallow that we are dealing with through OT, CST.
When mom pumps, and she has been pumping now for about 4 days, she gets 3-8 cc of milk from each breast in about 5 minutes. Milk starts immediately, is fairly fast dripping or spraying for about 3-4 minutes, slows, she adds hands/ massage. Get a little more. Then nothing. 20 minutes later she can get same amounts. 3-8 cc, And again 20 minutes later. Yesterday we tried pumping 5 minutes after 1st pumping, she got some more, repeated 2 more times. Each time she got some milk, quickly and briefly. Then again after 20 minutes she was back up to original amounts. We were trying to see if we could coax her body to have more frequent let-downs as it is clear from baby behavior and test weighs that what we are seeing with pump is happening for baby.
I think what's confounding me is the quick and brief. Mom tells me that at 3 am the milk is dripping before she can get to the pump, and she gets more milk. But when it stops it STOPS. I have mentioned chewing almonds and rescue remedy, I'll suggest warmth on the breast while pumping too. Anything else?
She will talk to dr. Re domperidone. She has started some herb mixes. Breast grew during pregnancy, feel a little soft, she didn't get engorged, was on birth control pills starting in high school for acne. Periods only regulated once off pills a few months before she got pregnant. I am wondering if that's the underlying cause. Is there anything new that helps?
Though baby is still below birth weight at 3 weeks, has gained an oz / day for last week. Had gained 4 oz from day 4-6, lots of wet and poopy diapers, good behavior patterns, seemed like everything was fine. Day 6- day 15 no weight gain. Surprise! Argh. Day 15-18 1 oz gain. Day 18 -24 yesterday 7 oz. but lots of effort. We are tube feeing at breast, baby takes in double or more what she gets from the tube, so that seems to be a good tool. They occasionally finger feed with tube and have given some milk with bottles 1 or 2 times when baby gets too tired upset to work in the middle of the night. If mom pumps enough times she has more milk than the baby will take. For example yesterday there was 70 cc milk. Baby took 38cc at breast with feeding tube. Scale showed net gain of 2.3 oz. baby took a break, peed pooped looked around, gazing relaxed and content. Started to show cues 20 or so minutes later. Mom had pumped meantime. Baby went onto breast with 32 cc of milk available, didn't finish it. Took herself off went to sleep. Dad got her to suck on his finger and I cajoled last 10 cc into her mouth using syringe. Didn't want to waste it. Though I didn't test weigh this time. I did under similar circumstances 2 days before, and at that last feeding before nap had taken .8 oz with 10 cc in tube. Yes almost a whole oz. I was happy and surprised that time.
Sorry this is long and so much detail. I am cheering them on. Mom says she will pump 20 x day to get enough milk. I have encouraged them to keep feedings to 45 minutes or so, giving her enough time to pump, but also not rush the baby who needs to eat slowly, as she seems to need to reset after almost every swallow. Her swallows are loud, off too. Hence Ot CST.
Thanks for listening. I look forward to any suggestions.
Janet Dombro, IBCLC
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