An IBCLC colleague is enjoying her new granddaughter, and her DIL is enjoying breastfeeding for the first time. This colleague says permission has been given to share this breastfeeding story in order to get some additional ideas... So this is a G2 P2, breastfeeding for the first time; has history of breast augmentation. Baby was born at about 37 weeks (via repeat surgical delivery) and around 6lb at birth. Baby sometimes had difficulty latching and once latched did not sustain breastfeeding for long enough. Lost close to 10% birth weight. At this point breastfeedings were topped off with formula and pumping post-BF was initiated with a hospital-grade rental, which the mother rented for post-discharge use. A nipple shield was used with improved, but not optimal, results, e.g. infant outputs. 

Mother has continued to BF first, complement with EBM  as available and follow with p.r.n. formula, plus pumping with a rental pump. Baby continues to sustain BF only when using a shield. Satiety is never demonstrated via BF alone or BF plus EBM (hence the formula use); after a couple of weeks, test-weighing a few times showed milk transfer of 0.5 oz/15ml or gm average via BF. So baby still seems to have some transfer issues...

Mother gets significantly more via one breast than the other via pumping, and has taken fenugreek, blessed thistle, etc. However, the apparent lack of satiety with follow-up EBM is the current mystery. No amount of EBM seems to satisfy the baby. According to the IBCLC grandmama, the EBM has only a very thin layer of fat at the top once it separates. She wonders what her DIL might do to increase the fat content of the milk. I'm wondering if she's getting mainly foremilk via difficulty "letting down" for the pump so fat is lower. (Their next call is to the DIL's OB care provider to see if he/she might prescribe domperidone and/or pit nasal spray from a compounding pharmacist.) I've also suggested Lisa M's/Diana W's Low Milk Supply site and MOBI moms.

At any rate, she's not currently on Lactnet but would appreciate any/all additional thoughts, which I've promised to forward... Thanks a heap!

Karen G

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