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Thread: In need of some guidance on decrease of milk supply after an episode of plugged ducts

  1. #1

    Smile In need of some guidance on decrease of milk supply after an episode of plugged ducts

    Dear moms,

    I am in need of some guidance/help here as I am faced with a mother who I was attending to during pregnancy until now. Her baby was born via natural birth, un-medicated and her baby was able to regain back the birth weight by the 13th day of life.

    Despite the initial breastfeeding challenges, we had managed to work out a feeding plan and it was all going well for her until she had an episode of plugged ducts on her right breast last week (apparently due to an ill fitting bra worn during sleeptime).

    We had managed to relief the plugged ducts discomfort, however, now the mother is telling me that her affected breast is not producing enough milk. Upon clarifying "not enough milk" she had mentioned that prior she was able to express 3oz each on both sides and she is now only able to do less than 1oz on the affected side and 3 to 4 oz on the good side.

    The mother is also telling me that her baby fusses when placed on the affected breast to nurse and she had then given 1 feeding of formula (5oz). So far she had given about 2-5 feeds of formula.

    I had given her some information and a feeding plan that includes, babymoon, skin-to-skin contact, frequent pumping after nursing, especially in the night, in hope to bring back the milk supply back to normal on the right breast.

    That was 2 days ago, and now she is telling me that her supply is yet to be back to normal. As I have no physical contact with the mother for the time being, I am unable to assess further.

    The mother has no prior health issues and apart from the minor nipple discomfort during the initial days, feeding has been going on well. Nipples are of adequate size, no signs of hypoplasia - these have been ruled out when I visited her teh day after she delivered her baby.

    Should I be asking the mother to call on the aid of a galactogogue ->fenugreek/Motherlove or is there something that I've missed out in my observation.

    I apologise for the long winded message, but it is quite difficult for me to find good reference in my country of residence considering that there are currently no Lactation Consultants/IBCLCs and I am the only (and first) Certified Lactation Educator Counselor.

    Appreciate your good advise

  2. #2
    Join Date
    Jan 2006
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    18,063

    Default Re: In need of some guidance on decrease of milk supply after an episode of plugged d

    5 oz of formula is alot for a baby of that age.

    I bet in a day or two if she ditched the bottle she would feal beter and there would be more milk.

    How about telling her to count diapars? LAy out 6 in the am and if baby hasn't wet them by dinner time try to nurse a few times before bed.

    She isn't trying to feed every 4 hours or some crazy longer block?

  3. #3
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    Jan 2006
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    Default Re: In need of some guidance on decrease of milk supply after an episode of plugged d


  4. #4
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    May 2006
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    Default Re: In need of some guidance on decrease of milk supply after an episode of plugged d

    Welcome! How cool that you're working in lactation education. I hope you'll stick around the forum- lots of mamas needing help here, and lots to be learned, as well!

    Her baby was born via natural birth, un-medicated and her baby was able to regain back the birth weight by the 13th day of life.
    You might want to reassure her that being back to birthweight by 2 weeks is terrific. Just what you want to see.

    all going well for her until she had an episode of plugged ducts on her right breast last week (apparently due to an ill fitting bra worn during sleeptime).
    So, obviously, no more ill-fitting bras! She may want to avoid them altogether during the night. If leaking is a concern, just sleep on a towel.

    We had managed to relief the plugged ducts discomfort, however, now the mother is telling me that her affected breast is not producing enough milk. Upon clarifying "not enough milk" she had mentioned that prior she was able to express 3oz each on both sides and she is now only able to do less than 1oz on the affected side and 3 to 4 oz on the good side.
    1 oz is actually a very normal amount of milk to express. 3-4 oz per breast is in oversupply territory, and oversupply actually increases the risk of plugged ducts so it's something you don't want.

    How much a mom is able to pump or hand-express depends on the following:
    1. How long it has been since she last nursed or pumped.
    2. Time of day. (Supply normally fluctuates, with many moms reporting the most abundant supply at night and in the morning, and the least supply in the afternoon and evening.)
    3. The type of pump the mom is using. Good double electric pumps usually extract the most milk, cheap manual pumps the least.
    4. Mom's response to pumping or hand expression. Not all moms respond well to the pump/hand.
    5. Mom's skill with pumping or hand expression.
    6. How long mom has been nursing. A mom who has been nursing for a while will likely have a supply that meets her baby's needs very exactly, without a lot of extra to pump out.

    The mother is also telling me that her baby fusses when placed on the affected breast to nurse and she had then given 1 feeding of formula (5oz). So far she had given about 2-5 feeds of formula.
    5 oz?! Whoa. That's a LOT of fluid for such a young baby. Most young babies take in around 1-3 oz at the breast.

    Fussing at the breast is normal. The baby may miss the fast flow, or may be reacting to the taste of the milk in the breast with lower supply. Sometimes a plugged duct will produce very salty milk, and babies don't always like it.

    I had given her some information and a feeding plan that includes, babymoon, skin-to-skin contact, frequent pumping after nursing, especially in the night, in hope to bring back the milk supply back to normal on the right breast.
    Excellent advice! However, she probably doesn't need to worry much about the supply on the right: it sounds like it is normal. She should follow your advice, cut out the formula, and nurse as often as possible. That will ensure an adequate supply. If she is worried that the baby isn't taking in enough milk, she should count diapers. Good diaper output = good milk input. (Here's a reference: http://www.kellymom.com/bf/supply/enough-milk.html)

    Should I be asking the mother to call on the aid of a galactogogue ->fenugreek/Motherlove or is there something that I've missed out in my observation.
    It wouldn't hurt, but it's probably not necessary.
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
    Coolest thing my little girl sang recently: "I love dat one-two pupples!"

  5. #5

    Default Re: In need of some guidance on decrease of milk supply after an episode of plugged d

    ooohhh thank you all for your advise and support!

    It is such a relief to get a response from fellow breastfeeding moms alike

    Counting diapers is definitely a good point and I'll be sure to discuss this with the mother.

    About the formula feeding, there is this mentality (especially in Asian countries/communities) that babies cry because they are hungry, but they fail to see beyond that babies cry for a lot of reasons! It could be they just want to be picked up, soothed, entertained etc...and due to their hardwired sucking reflex, they are bound to suck any milk which is offered in the bottle.

    The baby is only 2.5months old and already 5oz is being introduced. I've seen and come across 2 day old infants who are fed with 2oz of formula as "top-up" as apparently the mother's milk is not enough....it seems like breastfeeding education still has a long way to go..

    The mother co-sleeps with the baby and in that context, unrestricted nursing is definitely evident

    Thank you all once again

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