This has come up in Israel also especially with 7 babies +, and we've found
the milk coming in later and later, and the mothers nursing for less time
durations.
Part of it has to do with nipple elasticity (the more babies nursed, the
harder it is to milk the breast, because the nipple just stretches with
each baby), and part of it has to do with mother never having developed
Prolactin Receptor Sites with younger babies because she has always nursed
culturally (supplemental bottles from the beginning, sleeping all night w/
baby in nursery,etc) and not ecologically (with baby 24 hrs a day from
delivery).
I have no answers because am  looking for some myself,

Nofia

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: From: Donna Zitzelberger RN BSN IBCLC <[log in to unmask]>
: To: [log in to unmask]
: Subject: Poor weight gain
: Date: Saturday, June 14, 1997 7:37 AM
:
: >I have a mom with baby #7 whose milk supply is not sufficient for this
: >baby.  She nursed 6 other children with no problems, good weight gain,
: >etc.  She went back to the doctor for a 2 week weight check, and this
: >baby had not gained from discharge weight.
:   Baby had had appropriate wet diapers, but not much
: >stooling.  Mom had not picked up on the lack of stooling as something to
: >be concerned about... She had
: >not noticed anything different with this baby's nursing.  Pregnancy,
: >labor, and delivery were all normal... After
: >a week of pumping at least 6x/day, starting out with a 24 hour trial
: >pumping to evaluate supply, she was getting a max of 5-6 oz/day.
: >Baby has been willing to go to breast and will suckle 15-20 min on one
: >breast, but not very long on the other breast...  She has noticed that
the
: >non-preferred breast has been smaller than the other breast all along,
: >something she did not notice with other children.
: >Pat Bucknell, IBCLC
: >Avon Lake Ohio
: >
:
: Pat -
:
:         My first thought on this case was an imbalance with foremilk and
: hindmilk.  This was further supported by the fact that baby goes to only
one
: breast per feeding.  The baby was urinating well which indicated a good
: supply of milk, but was probably getting mostly foremilk. Perhaps mom's
milk
: supply is low at this point because baby has not been adequately
stimulating
: both breasts.  Were you able to do a suck eval or was it a phone consult?
 I
: would be curious as to the positioning of mom,  of the baby at the
breast,
: and the feel of baby's suckle.  Has the baby been a sleepy baby?  Sleepy
: babies have that tendency to give up on suckling unless the breast is
: offered in the perfect position.
:
:         I wonder if mom is able to adequately evaluate the baby's suck if
: she did not pick up on the baby's lack of stools.  With 6 other children
to
: care for, it may be difficult for her to make a thorough assessment.  I
also
: am wondering about her ability to get enough rest and recovery and this,
in
: turn, negatively affecting her milk supply.
:
:         In sum,  I would rule out the following two problems:
:
:         1.  Poor weight gain initially due to foremilk/hindmilk
imbalance;
: currently due to low milk supply
:
:         2.  Low milk supply due to poor breast stimulation and possible
: maternal overactivity
:
:
:         Let us know what happens.
:
:         Donna Zitzelberger  RN BSN  IBCLC