Hi again,
thanks to those who responded about my client who has low supply,
especially Linda Smith who provided ++++ info.  Tomorrow is two weeks
postpostpartum and I should say no supply not low supply.  I saw her
day 6 and the routine has been nurse her baby 15--20 min. each side,
use SNS (baby usually takes about 3-4 oz now in 15 min) and pump with double
pump x 15 min. every 3 hours.  Mother has even been hand expressing after the
electric pump.  Still nothing (only droops).  We have addressed
latch, reaching sinuses, positioning, suck assessment etc. Day 8 I
was concerned re a golf ball sized clot and a few small ones the next
day - but that has slowed.  I asked that her Birthing Centre nurse
check her fundus & draining hematoma from her C/S but the nurse told
the mother she wasn't worried about any of that.  I encouraged the
mother to see her OB but cannot see her until Thursday.  I talked to
another OB and he wasn't much help - he said 3 things control milk -
breast tissue (and that appeared to have been normal and developed
normally during the pregnancy), pituitary (Sheehan's and I had ruled
that out and no other indications of pituitary problems) and thirdly
he said stress inhibiting let down - I indicated that this didn't
seem likely. His reply was "She's a woman isn't she". What can I say.
I asked about retained placenta and he said it has no relation to
breastfeeding or ability to make milk!  He told me all about
domperidone and I listened politely (it appeared that he thought I
would know nothing about these things). He also explained to me how
to apply a breast pump and that it always should be done with the
baby nursing on the other side to stimulate letdown.  He has referred
to me in the past so I'm not sure why he talked to me as if I
wouldn't know all this (but maybe I'm too sensitive).
I gave her Dr. Newman's handout on Domperidone to read or take
to her OB.  She is really getting tired now after 6 days of all this.
So I advised her to just feed (she is supplementing at breast) for
today and try to relax.  She is intelligent and feels all her dreams
about birthing and motherhood are dashed but she does want answers
why she has never made milk?  I'm not sure how much longer she'll
keep up the pumping etc. Perhaps the OB will investigate retained
placenta. Could all this breast/nipple stimulation be keeping her
uterus constricted enough that she doesn't bleed?( from a piece of
retained placenta). My A & P may be a little weak here. My faith in
mother nature has been dashed (but perhaps some
interventions/complications of her delivery did it and it hasn't been
figured out yet) I've only been exposed to perceived insufficient
milk syndrome not "real".  Thanks for listening.
Nancy Nurmi
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10 Hanley Street
Thunder Bay, Ontario
CANADA  P7A 6V2
(807)345-1013