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Recognizing Breastfeeding Problems

I’m spending time this week (spring break) to work through the postpartum study guide I need to complete for school.  In the process I found an interesting list in Varney’s of reasons a woman may be experiencing inadequate milk supply.  How timely, someone had just asked this on the Facebook fan page last week.

So what does Varney list?

  1. Infrequent or scheduled feedings, not on cue
  2. Replacing or spacing breastfeeding with pacifier
  3. Replacing breastfeedings with formula or baby foods
  4. Compression of milk-making cells (too tight bra, engorgement)
  5. Use of nipple shields
  6. Stopping night feedings too soon
  7. Poor letdown
  8. Prematurity, dysmaturity
  9. Retained placental fragments
  10. Inadequate glandular tissue (ofeten presents with breasts of markedly discrepant size)
  11. Class 2 or 3 inverted nipples
  12. Poor milk transfer by the infant
  13. Breast surgery or injury
  14. Cigarette smoking by the mother
  15. Drugs or medications that could negatively impact milk supply
  16. Endocrine (especially thyroid) problem

This was a few more reasons than I would have quickly listed, and a good reminder that not every woman who is experiencing poor milk supply is having the same problem. So what was the issue with last week’s reader?  Let’s try to figure it out.

We know a few things about this mother.  She was breastfeeding post cesarean surgery but with a poor latch.  She utilized the services of a lactation consultant and a nipple shield and within about two months was feeling successful at nursing. Around three months the milk stopped flowing.  She attempted to increase her supply by using supplements (for mom), increasing fluids, pumping before and after feedings to stimulate more milk production but the flow continued to decrease and ultimately her breasts were dry.

From her description we can rule out several items on the list, specifically 5 (she is no longer using nipple shields), 8 (the baby was already 3 months old), 9 (this would have already been resolved), 10 and 11 (which the lactation consultant would have helped her discover and manage).  She was previously successful with breastfeeding, so we can guess that  7 and 12 do not apply to her case.

This leaves us with a few possibilities.   Since she was working with a lactation consultant, we can guess that she already knew about 1, 2 and 3 and 6 so would have avoided those, but we should still ask her anyway. We would need more history to assess the possibility of  13, 14 or 15, but the mother should be able to give us information about those relatively easily.  15 (medications) is quite likely since she may have been prescribed hormonal birth control at her six week postpartum visit and recently began using it.  If it was birth control related, changing the method should help restore supply.

Though I would NOT have come up with this without this list to work through, the next most likely cause would be 4 – her bra had become too tight. Around three months most babies will go through a growth spurt and will increase the mother’s milk supply.  This mother had already successfully passed through two growth spurts, so I doubt she would have failed to move through this one successfully.  But if we believe the signs in dressing rooms, most women wear the wrong sized bra anyway, and if her bra was too small before the increase in milk supply (perhaps she bought it during pregnancy) it could have been very restrictive after. This would be easy to check, all we have to do is ask her and look at her bra.

If her bra did fit well, we could consider 16 (thyroid problems) and may recommend she get a test.  But chances are her problem will be resolved before we get to this step.

What a good reminder that every breastfeeding couple is unique, and we need to work through all possible problems with the mother to understand what is causing her supply to decrease.

 

 

 

 

 

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Jennifer Vanderlaan CNM MPH is the author of the BirthingNaturally.net website. She has been working with expectant families since 2000, training doulas, childbirth educators, and midwives. She has worked with midwives in Central America and Sub-Saharan Africa. Her interest in public health grew in 2010, and she is now a PhD student learning to become a producer of knowledge.

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