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!
You might want to reassure her that being back to birthweight by 2 weeks is terrific. Just what you want to see.
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.
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.
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).
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.
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.
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.
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.
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.
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.
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)
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.
It wouldn't hurt, but it's probably not necessary.
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.
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