Re: Unexplained very low milk supply

[Guest guest]

Hi, Jaye.

Information in the article by Kay Hoover (and maybe another author?) states that a mother who had a theca lutein cyst started making breastmilk when her testosterone level dropped to 300 (from 800). This would seem to indicate that your mother's levels should allow breastmilk to be made.

TSH: was it below 0.5? The range of normal for non-pregnant women goes lower than that, but a pregnant woman might be hyperthyroid if below 0.5. There is more and more anecdotal evidence that breastfeeding women often do better with milk supply if their TSH stays within the range of normal for pregnant women instead of non-pregnant.

All that said, I have had a significant number of women get twice as much milk out using Medela's Classic than when they were using the Symphony. And I even had one woman get out FIVE times as much milk with the Classic compared to what she got using the Symphony. Any chance someone in your area still has a Classic? She would have to buy one or two parts to connect her kit to the Classic, depending on whether she has a straight Symphony kit or a Symphony/Lactina kit. Or could she switch to the Platinum by Ameda, which I'm told has the cylinder-driven technology? She would have to buy an Ameda collection kit. Medela kits don't fit on Ameda pumps.

Dee Kassing

To: Lactation Information and Discussion ; ; pplc Sent: Sun, August 12, 2012 10:13:22 PMSubject: Unexplained very low milk supply

Hi all,

PTP:

Mom is 36, has (fraternal) twin sister who has had exact same symptoms/problems re: milk supply with her baby. Their Mother had a great supply for them as babies – nursed for 6 months.

Mom is currently 9 days pp. Baby has structural issues and is unable to breastfeed well at all. Mom is nursing for comfort, and using Symphony pump. I tested the pump, evaluated flange fit – all is fine there. Mom has nice veining on breasts and absolutely no signs of IGT. Breasts grew a full cup size during pregnancy (with both babies – she is having a repeat of supply issues with 2nd baby). She experienced her milk coming in on day 3 – 4 with extreme fullness but never pumped more than drops at that time – even with pumping q. 2 hrs. Mom started fenugreek 3 caps (610mg ea) 3 times per day. By day 6 was pumping no more than ½ - 1 oz q 2 – 2.5 hrs around the clock. And that is where she is today.

We did blood work: Thyroid, prolactin, and iron - ALL is absolutely FINE. The only hormone I am unsure of is testosterone which came in at 32 (range 14 – 76) – but I don’t know what a lactating mom’s testosterone levels should be and cannot find any information on that. Dr (thankfully) is willing to rule out retained placenta with ultrasound – but moms prolactin levels are high (180.3, day 7 pp, not sure if before or after pumping) so I am thinking retained placenta is not the issue and Dr checked her bleeding and said all is normal there.

Moms labor and delivery were uncomplicated and . Baby born full term. Mom on IV Fluids for approximately 15 hours, given Pitocin at lowest levels for approx. 10 hours, then an (light – Anesths words) Epidural for approximately 6 hours – 1 bolus and then a 2nd dose just before delivery when they increased the Pit and then 30 min later, after 10 min. of pushing baby was born. Epidural had Fentanyl.

Mom busted her butt with last baby taking herbs and pumping like a mad-woman (q 2 hrs around the clock) with no more than 2 oz MAX able to be pumped and only once in a while (typically in the morning). She did this for 6 months before quitting. She is clearly looking at the same situation this time.

I am at a loss. Everything points to the fact that she should have milk and lots of it. No other medications are being taken, no other complications – I did the Assessing for Insufficient Milk Supply a la Marasco – and nothing. Everything points to being just fine. I have her contacting her mother to see if mom took any medications during pregnancy with her twin daughters since both women have had the same problem. My client has done everything ‘by the book’ right to ensure no mismanagement and the best possible outcome, she has no history of abuse, hormonal issues, no signs of hormonal issues, got pregnant very easily, is on no medications (now or during pregnancy), no history of breast surgeries or injuries of any kind.

In my nearly 18 yrs I have only had one other case where it all looked perfect, all the tests, and everything – but still very little milk. Thoughts?

Thank you!

Jaye Simpson, CLE, IBCLC, CIIM, MoM

Breastfeeding Network

www.breastfeedingnetwork.net

[Guest guest]

Oh, and if she can find a Classic, be sure to remind her that for most women, it takes three days of sending the same message to the body before the body says, "Hmmm. You really mean it. Okay, here you go." So she shouldn't expect to see more milk until Day 4 of pumping with the different pump. If she sees an increase sooner, that's "just gravy"! If I forget to tell the mothers this, they get upset when they don't *immediately* pump more milk with the new pump.

Dee Kassing

To: Sent: Sun, August 12, 2012 11:12:03 PMSubject: Re: Unexplained very low milk supply

Hi, Jaye.

Information in the article by Kay Hoover (and maybe another author?) states that a mother who had a theca lutein cyst started making breastmilk when her testosterone level dropped to 300 (from 800). This would seem to indicate that your mother's levels should allow breastmilk to be made.

TSH: was it below 0.5? The range of normal for non-pregnant women goes lower than that, but a pregnant woman might be hyperthyroid if below 0.5. There is more and more anecdotal evidence that breastfeeding women often do better with milk supply if their TSH stays within the range of normal for pregnant women instead of non-pregnant.

All that said, I have had a significant number of women get twice as much milk out using Medela's Classic than when they were using the Symphony. And I even had one woman get out FIVE times as much milk with the Classic compared to what she got using the Symphony. Any chance someone in your area still has a Classic? She would have to buy one or two parts to connect her kit to the Classic, depending on whether she has a straight Symphony kit or a Symphony/Lactina kit. Or could she switch to the Platinum by Ameda, which I'm told has the cylinder-driven technology? She would have to buy an Ameda collection kit. Medela kits don't fit on Ameda pumps.

Dee Kassing

To: Lactation Information and Discussion ; ; pplc Sent: Sun, August 12, 2012 10:13:22 PMSubject: Unexplained very low milk supply

Hi all,

PTP:

Mom is 36, has (fraternal) twin sister who has had exact same symptoms/problems re: milk supply with her baby. Their Mother had a great supply for them as babies – nursed for 6 months.

Mom is currently 9 days pp. Baby has structural issues and is unable to breastfeed well at all. Mom is nursing for comfort, and using Symphony pump. I tested the pump, evaluated flange fit – all is fine there. Mom has nice veining on breasts and absolutely no signs of IGT. Breasts grew a full cup size during pregnancy (with both babies – she is having a repeat of supply issues with 2nd baby). She experienced her milk coming in on day 3 – 4 with extreme fullness but never pumped more than drops at that time – even with pumping q. 2 hrs. Mom started fenugreek 3 caps (610mg ea) 3 times per day. By day 6 was pumping no more than ½ - 1 oz q 2 – 2.5 hrs around the clock. And that is where she is today.

We did blood work: Thyroid, prolactin, and iron - ALL is absolutely FINE. The only hormone I am unsure of is testosterone which came in at 32 (range 14 – 76) – but I don’t know what a lactating mom’s testosterone levels should be and cannot find any information on that. Dr (thankfully) is willing to rule out retained placenta with ultrasound – but moms prolactin levels are high (180.3, day 7 pp, not sure if before or after pumping) so I am thinking retained placenta is not the issue and Dr checked her bleeding and said all is normal there.

Moms labor and delivery were uncomplicated and . Baby born full term. Mom on IV Fluids for approximately 15 hours, given Pitocin at lowest levels for approx. 10 hours, then an (light – Anesths words) Epidural for approximately 6 hours – 1 bolus and then a 2nd dose just before delivery when they increased the Pit and then 30 min later, after 10 min. of pushing baby was born. Epidural had Fentanyl.

Mom busted her butt with last baby taking herbs and pumping like a mad-woman (q 2 hrs around the clock) with no more than 2 oz MAX able to be pumped and only once in a while (typically in the morning). She did this for 6 months before quitting. She is clearly looking at the same situation this time.

I am at a loss. Everything points to the fact that she should have milk and lots of it. No other medications are being taken, no other complications – I did the Assessing for Insufficient Milk Supply a la Marasco – and nothing. Everything points to being just fine. I have her contacting her mother to see if mom took any medications during pregnancy with her twin daughters since both women have had the same problem. My client has done everything ‘by the book’ right to ensure no mismanagement and the best possible outcome, she has no history of abuse, hormonal issues, no signs of hormonal issues, got pregnant very easily, is on no medications (now or during pregnancy), no history of breast surgeries or injuries of any kind.

In my nearly 18 yrs I have only had one other case where it all looked perfect, all the tests, and everything – but still very little milk. Thoughts?

Thank you!

Jaye Simpson, CLE, IBCLC, CIIM, MoM

Breastfeeding Network

www.breastfeedingnetwork.net

[Guest guest]

Thyroid was 1.09 - range was .5 – 5.0 and Testosterone was 32 with range 14-76 BUT – where can I find good information on these hormone levels and what they should be? Sadly, my books with information like this are outdated and I am unable to purchase new ones at the moment. I wish to goodness I could get my hands on a Classic pump! I don’t think they are anywhere in my area anymore. BUT – here is the clincher/confounder: Mom’s fraternal twin sister had the same issues with her baby. Maybe this is a red herring, but I find it interesting that they both had the same issue but their mother was fine. It just makes me wonder if their mother took something when pregnant that caused this problem for both girls. Jaye Simpson, CLE, IBCLC, CIIM, MoMBreastfeeding Networkwww.breastfeedingnetwork.net

[Guest guest]

What about an aunt or grandmother on mom's side -- and for that matter, why couldn't dad's side figure into it? We've blown off the "my mother, aunt, sister, cousin didn't have enough milk" which was probably true back in the 40's thru 60's where everyone was told to breastfeed on one side only every four hours (LLL folk excepted!!) and it was a management issue. But I wonder more about familial concerns now, and think someone oughta do a study on it!!

Jan

Thyroid was 1.09 - range was .5 – 5.0 and Testosterone was 32 with range 14-76

BUT – where can I find good information on these hormone levels and what they should be? Sadly, my books with information like this are outdated and I am unable to purchase new ones at the moment.

I wish to goodness I could get my hands on a Classic pump! I don’t think they are anywhere in my area anymore.

BUT – here is the clincher/confounder: Mom’s fraternal twin sister had the same issues with her baby. Maybe this is a red herring, but I find it interesting that they both had the same issue but their mother was fine. It just makes me wonder if the ir mother took something when pregnant that caused this problem for both girls.

Jaye Simpson, CLE, IBCLC, CIIM, MoM

Breastfeeding Network

www.breastfeedingnetwork.net

[Guest guest]

the only thing I can think of is she simply does not respond to pumping well. I believe I've seen this, also. Beebe, M.Ed., RLC, IBCLC Lactation Consultant/Postpartum Doula www.second9months.comwww.facebook.com/thesecond9months To: Lactation Information and Discussion ; ; pplc Sent: Sunday, August 12, 2012 8:13 PM Subject: Unexplained very low milk supply

Hi all, PTP: Mom is 36, has (fraternal) twin sister who has had exact same symptoms/problems re: milk supply with her baby. Their Mother had a great supply for them as babies – nursed for 6 months. Mom is currently 9 days pp. Baby has structural issues and is unable to breastfeed well at all. Mom is nursing for comfort, and using Symphony pump. I tested the pump, evaluated flange fit – all is fine there. Mom has nice veining on breasts and absolutely no signs of IGT. Breasts grew a full cup size during pregnancy (with both babies – she is having a

repeat of supply issues with 2nd baby). She experienced her milk coming in on day 3 – 4 with extreme fullness but never pumped more than drops at that time – even with pumping q. 2 hrs. Mom started fenugreek 3 caps (610mg ea) 3 times per day. By day 6 was pumping no more than ½ - 1 oz q 2 – 2.5 hrs around the clock. And that is where she is today. We did blood work: Thyroid, prolactin, and iron - ALL is absolutely FINE. The only hormone I am unsure of is testosterone which came in at 32 (range 14 – 76) – but I don’t know what a lactating mom’s testosterone levels should be and cannot find any information on that. Dr (thankfully) is willing to rule out retained placenta with ultrasound – but moms prolactin levels are high (180.3, day 7 pp, not sure if before or after pumping) so I am

thinking retained placenta is not the issue and Dr checked her bleeding and said all is normal there. Moms labor and delivery were uncomplicated and . Baby born full term. Mom on IV Fluids for approximately 15 hours, given Pitocin at lowest levels for approx. 10 hours, then an (light – Anesths words) Epidural for approximately 6 hours – 1 bolus and then a 2nd dose just before delivery when they increased the Pit and then 30 min later, after 10 min. of pushing baby was born. Epidural had Fentanyl. Mom busted her butt with last baby taking herbs and pumping like a mad-woman (q 2 hrs around the clock) with no more than 2 oz MAX able to be pumped and only once in a while (typically in the morning). She did this for 6 months

before quitting. She is clearly looking at the same situation this time. I am at a loss. Everything points to the fact that she should have milk and lots of it. No other medications are being taken, no other complications – I did the Assessing for Insufficient Milk Supply a la Marasco – and nothing. Everything points to being just fine. I have her contacting her mother to see if mom took any medications during pregnancy with her twin daughters since both women have had the same problem. My client has done everything ‘by the book’ right to ensure no mismanagement and the best possible outcome, she has no history of abuse, hormonal issues, no signs of hormonal issues, got pregnant very easily, is on no medications (now or during pregnancy), no history of breast surgeries or injuries of any kind. In my nearly 18 yrs I have only had one other case where it all looked perfect, all the tests, and everything – but still very little milk. Thoughts? Thank you! Jaye Simpson, CLE, IBCLC, CIIM, MoMBreastfeeding Networkwww.breastfeedingnetwork.net

[Guest guest]

And that is where I'm at thinking about this.

Does pumping feel comfortable? There should be no discomfort. Could you still try a larger breastshield?

Does the nipple enter the shield tunnel? it should go into it and move back and forth.

Also, keep the pump, pumping on the highest speed if a let down hasn't occurred when the pump slows down..

Ellen Simpson, IBCLC

Tampa, FL

the only thing I can think of is she simply does not respond to pumping well. I believe I've seen this, also.

Beebe, M.Ed., RLC, IBCLC Lactation Consultant/Postpartum Doula

[Guest guest]

" She experienced her milk coming in on day 3 – 4 with extreme fullness but never

pumped more than drops at that time – even with pumping q. 2 hrs. "

If she has long term milk stasis, meaning the milk is not being removed, the

milk producing cells atrophy. Now she is on day 9, 6 days after lact II. I'm

sure her supply is dwindling....she may have lack of letdown to the pump (in

that case hand expression should have been producing some yield), or previous

breast surgery, that is interfering with the junction of the milk ducts and

nipple pore openings (I'm sure you have ruled this out, but this is something I

see women with a hx of reduction with outer areolar incisions experiencing on

occasion).

>

> Hi all,

>

>

>

> PTP:

>

>

>

> Mom is 36, has (fraternal) twin sister who has had exact same

> symptoms/problems re: milk supply with her baby. Their Mother had a great

> supply for them as babies – nursed for 6 months.

>

>

>

> Mom is currently 9 days pp. Baby has structural issues and is unable to

> breastfeed well at all. Mom is nursing for comfort, and using Symphony

> pump. I tested the pump, evaluated flange fit – all is fine there. Mom has

> nice veining on breasts and absolutely no signs of IGT. Breasts grew a full

> cup size during pregnancy (with both babies – she is having a repeat of

> supply issues with 2nd baby). She experienced her milk coming in on day 3 –

> 4 with extreme fullness but never pumped more than drops at that time – even

> with pumping q. 2 hrs. Mom started fenugreek 3 caps (610mg ea) 3 times per

> day. By day 6 was pumping no more than ½ - 1 oz q 2 – 2.5 hrs around the

> clock. And that is where she is today.

>

>

>

> We did blood work: Thyroid, prolactin, and iron - ALL is absolutely FINE.

> The only hormone I am unsure of is testosterone which came in at 32 (range

> 14 – 76) – but I don't know what a lactating mom's testosterone levels

> should be and cannot find any information on that. Dr (thankfully) is

> willing to rule out retained placenta with ultrasound – but moms prolactin

> levels are high (180.3, day 7 pp, not sure if before or after pumping) so I

> am thinking retained placenta is not the issue and Dr checked her bleeding

> and said all is normal there.

>

>

>

> Moms labor and delivery were uncomplicated and . Baby born full term. Mom

> on IV Fluids for approximately 15 hours, given Pitocin at lowest levels for

> approx. 10 hours, then an (light – Anesths words) Epidural for approximately

> 6 hours – 1 bolus and then a 2nd dose just before delivery when they

> increased the Pit and then 30 min later, after 10 min. of pushing baby was

> born. Epidural had Fentanyl.

>

>

>

> Mom busted her butt with last baby taking herbs and pumping like a mad-woman

> (q 2 hrs around the clock) with no more than 2 oz MAX able to be pumped and

> only once in a while (typically in the morning). She did this for 6 months

> before quitting. She is clearly looking at the same situation this time.

>

>

>

> I am at a loss. Everything points to the fact that she should have milk and

> lots of it. No other medications are being taken, no other complications –

> I did the Assessing for Insufficient Milk Supply a la Marasco – and

> nothing. Everything points to being just fine. I have her contacting her

> mother to see if mom took any medications during pregnancy with her twin

> daughters since both women have had the same problem. My client has done

> everything `by the book' right to ensure no mismanagement and the best

> possible outcome, she has no history of abuse, hormonal issues, no signs of

> hormonal issues, got pregnant very easily, is on no medications (now or

> during pregnancy), no history of breast surgeries or injuries of any kind.

>

>

>

> In my nearly 18 yrs I have only had one other case where it all looked

> perfect, all the tests, and everything – but still very little milk.

> Thoughts?

>

>

>

> Thank you!

>

>

>

> Jaye Simpson, CLE, IBCLC, CIIM, MoM

>

> Breastfeeding Network

>

> www.breastfeedingnetwork.net

>