Breastfeeding/Lactation Consultant

NAK

Pumping is NEVER a good way to determine how much supply a mom has. Pumping is in part a learned skill because the way milk is extracted is different than baby. Keep in mind that in looking at if mom has Overspply/fast letdown, the amount mom pumps is not even a factor. http://www.kellymom.com/bf/supply/fast-letdown.html

Also keep in mind that getting 2 ounces per pumping session is at the high end. Most moms who are BF full-time get between .5 and 2 ounces per pumping session (NOT per breast). http://www.kellymom.com/bf/pumping/pumping_decrease.html#normal

It does concern me that pumping is hurting (and if it is hurting that usually means less milk). Many moms need larger horns than is "standard".

From the Ameda website:
"One way to know you need a larger flange is if pumping hurts, even on low suction. But there are other ways to tell. You can, for example, measure your nipple. If your nipple at rest is as wide as a US nickel (22 mm) or larger, you likely need a larger size. But even if your nipple is smaller than a nickel, you might still need a different flange size because the breast changes as you pump." more here: http://www.ameda.com/breastpumping/most/fit.aspx

FOllow up as necessary.

Sorry, I forgot already what Carol posted!

What pumpi is mom using? Yes, she can STILL have oversupply andnot pump gallons of milk. Absolutely. What is baby's nursing pattern, are feeding sessions scheduled at all? How often is she pumping? Has she done any sort of block nursing?

Keep in mind that most women only get betwee .5-2 ounces per pumping session. So, getting more than 2 ounces is a session is quite a lot. How much is she getting, and how spaced out are the pumping sessions from the last nursing/pumping session? One hour? Four?

WHat about baby's latch...has that been dealt with if it's causing poor milk transfer leading do the plugged ducts?

Do you know the specific dosage and meds she has been on for the thrush?

 

It’s true that pump volumes aren’t a good judge of oversupply but I’d be really reluctant to say its oversupply if she’s working with an LC.

The thrush can cause continued pain with pumping (especially burning) even on a low setting. Bacterial infection can cause the same symptoms. Often if a mom is not responding to what seems like thrush it may also be bacterial and need antibiotics in addition to yeast treatments. Some moms need to hit the yeast hard, heavy and long to see improvement. It can be very tricky to figure out what exactly is going on yeast vs bacteria or both and she should be working closely with the LC and her OB doctor. (they should also be talking to each other …the LC and doc)

The plugs and mastitis can be from continued inflammation b/c of unresolved infection (yeast or bacterial). Yes, it can also be from oversupply…………sigh……..as my family doc loves to say……everyone is entitled to more than one problem….It could actually be a combination of infection and oversupply, and a poor latch and related to the shield. However, the shield may be helping. Again, this definitely sounds like a job for an in person LC and doctor.

Certainly it would be important to check the flange sizes too but I bet that’s not the entire picture. Ameda has a very nice picture of how they should fit on their site.

When moms have complex problems such as this it’s important for them to be persistent with their health care providers and LC’s and make sure they are aware that she is not responding or not responding completely to the treatments. She can also ask for another opinion of either the LC or the doctor or both if she feels they are not able to help. A good LC and good doctor will refer to someone else if they are not able to help anyway.