help with client

[Guest guest]

I am wondering if you have any advice. I am working with a 23 year old with her 2nd child. I helped her with her first, and she had very low milk supply, unexplained. Breasts rounded, got preg spontaneously, etc. The client never ended up doing blood work, but after intensive pumping she only got our around 30 cc each time.This time around, she took Malanguy from her 7th month of preg and began pumping from a few hours after birth. She had a 35 week premie.The first week she was only pumping because baby was in the NICU. She has been pumping every 3 hours or more often. Basically, her baby is now BF about 30-40 cc and then taking a supplement of another 40 by bottle. Because last time she in her words was “absolutely obsessive” about the pumping to the point where she did not even enjoy her baby, and kept it up until about 6 months while only pumping about 10 cc each time, she does not want to repeat that experience. So she is nursing every feed and has a scale, and the baby is taking out about 1/3 to ½ of what he needs. The thing is, when she pumps the first 2 feeds in the morning after sleeping the whole night, she can get out 90-100. Why can she not get this throughout the day??? If it was a small storage capacity thing which I thought it was, then she would never be able to get out more than like 40cc. The baby’s suck is fine, no TT, not posterior or anything. Her milk supply is just very low. I don’t know what to tell her.She does not want to touch a FF tube, as she hated it last time.She does not want to pump after each feed, as she is not good at relaxing, and therefore became obsessive.On the other hand, she is a real over achiever and will not rest as to why she is not producing enough milk.Next step is blood work. What besides thyroid and prolactin? She feels her supply is going down- I just don’t think there is much more in the breast than the 40 that the baby is taking out- I actually thought the baby did a very good job nursing.Sorry this is rambling, I am zonked from working during summer vacation with the kids on vacation!!! Billowitz, IBCLCIsrael

[Guest guest]

Yes, this mom said at the outset she cannot do all the pumping she did last time, so she is skipping the night pumping. I explained how this may affect her prolactin, but the truth is that she is actually getting the same amount overall in the night hours as when she got up to pump. She was getting up for about 3 weeks and did not see any increase.She has made a conscious decision to not pump as much as she was in the first three weeks because she has not seen results and was very over involved with her first birth. So I am limited. But I do understand her. She did everything last time and this time for 3 weeks and has just not seen results. This is frustrating. I think if I was in her place, as hard as it would be, I would choose to enjoy my baby and my other toddler, rather than spend all that time pumping and being frustrated. From: [mailto: ] On Behalf Of angela_hartfelder_ibclcSent: Wednesday, August 08, 2012 5:02 AMTo: Subject: Re: help with client Just wanted to clarify something on your post. You said, " when she pumps the first 2 feeds in the morning after sleeping the whole night " I'm sure you've already thought of this, or I likely misunderstood, but if this mother is sleeping the " whole night " , then depending on her definition of how many hours that may be, then she may only be pumping 4 to 6 times per 24 hour period. If she is dependent on that to build her supply, she'll find herself on the low end of the supply. If she is truly sleeping the whole night, you might discuss ways to make sure she is pumping 8 to 10 times per 24 hour period, with one of those being at night. All that milk stasis at her peak prolactin time will dial down her production. If however, I misunderstood " sleeping the whole night " , then just ignore everything I just said! *g* Hartfelder IBCLC, RLC__________ Information from ESET NOD32 Antivirus, version of virus signature database 7364 (20120807) __________The message was checked by ESET NOD32 Antivirus.http://www.eset.com