What could be wrong with this mom?

[Tiffany]

Mom begins pumping with hospital grade pump every 2 hours on postpartum day 2. After one week of pumping the daily volume is under 100 ml.

For the next week she spaces out pumping to every 3 hours with a 4-5 hr stretch at night because it's becoming too much work for 100 ml per day. Volume remains the same.

On the third week she starts domperidone 20mg 3xday and continues pumping, every 3 hours. Over the next week her volumes do not increase at all, still at about 95 ml per day.

By the end of the fourth week, she is discouraged and stops domperidone, pumps 3xday for a few days and gets 95 ml, then stops pumping.

A large intramammarry space is noted.

So, what could this mom's problem be? Is there anything else to be suggested?

[Jilian]

Is she on any medications that would reduce her supply? Has she had a breast reduction? Is she nursing at the breast at all or strictly punping?

Fenugreek and mother's milk tea can help increase your supply. Have you seen this mom pump? Is the pump getting proper suction around her breast and working properly? Has she tried a different pump?

[Tiffany]

She takes albuterol (inhaler) for asthma prn. No other medications. Has not had a breast reduction. Did not experience breast changes during pregnancy.

At the end of week 2 attempted baby at breast once per day for a week. Baby nursed well but because of poor supply didn't get much. The max amount baby got was 24 ml after nursing from both breasts. Other attempts were 4ml, 8ml, 4ml, 6ml, 16 ml.

She was pumping properly and using multiple hospital grade pumps.

[newbirth]

Quote:

Originally Posted by Tiffany Did not experience breast changes during pregnancy.

This set off all kinds of bells. She may have hypoplastic breasts, and may not be able to breastfeed due to not enough breast tissue. She might be successful using an SNS device so that the baby can still suckle at the breast getting whatever she can make, and supplementing with formula or borrowed human milk.

Here's some info:
http://www.007b.com/breast_size_breastfeeding.php
http://www.babycenter.com/refcap/bab...feed/8692.html

[MindOverLaborDoulas]

[AussieDoula]

Pumping can be hard... I know we have a few more experienced with lactation here, and hopefully they will be able to give some fantastic advice but in the meantime the usual checklist:

Is mama relaxed when she is pumping? I know that can be hard with the stresses of a new baby and frustrating if pumping just isn't going well. Try pumping while looking at a picture of baby, or in baby's presence to help encourage let-down.
Keep having baby attempt to nurse on demand. Always offer breast before anything else (baby is often far more efficient at helping increase your supply than even a hospital garde pump). Try pumping while nursing (if baby doesn't mind the noise) or immediately afterwards (5 - 10 minutes double pump ?) to completely empty the breasts (sometimes when milk production is low baby doesn't suck strongly, which means it doesn't stimulate more milk production).
It's important to make sure the breasts are emptied at each feeding/pumping session to help increase supply.
Take fenugreek (as Jilian suggested).
Cup or syringe feed supplements at the breast.

A wide intramammary distance is often associated with an "inadequate" supply. Sometimes it is just a case of delayed onset of a full supply, so hopefully that is the case here. Sometimes frequent feedings or pumpings don't make a significant difference, but it's worth trying (along with the Fenugreek and any medications prescribed).

I'm assuming this mama is working closely with a lactation specialist. If not, she might need to consider it.

Stay hydrated, eat a balanced meal, rest, and try some relaxation techniques.

I wish this mama the best of luck.

[newbirth]

Other ideas:

Is this a first time mom? Has she successfully breastfed before? Did she hemorrhage at birth?

[mothermedoula]

I know a woman who has a Pump in Style, but it just didn't work for her. She couldn't get any milk. She picked up an AVEDA hand pump and it seems to work great for her. Who knew!
Liz

[Stacie]

Quote:

Originally Posted by newbirth Other ideas: Is this a first time mom? Has she successfully breastfed before? Did she hemorrhage at birth?

Yes, both of these questions pooped un in m head.

Also, did she have any trouble getting pregnant? Could she have PCOS?

[Babies_Bellies_Boobies]

any chance of retained placenta?

skimming through, and tryign not to duplicate the other's suggestions...

is this mama also in canada?

any chance this mama could be seen at (or at least call) dr newman's breastfeeding clinic up there? i know he also takes and responds to emails, as i have chatted with him on several occasions. lemme grab ya his info.

Email Dr. Jack Newman at drjacknewman@sympatico.ca (please keep brief)
or she can Call Dr. Jack Newman at 416- 813-5757