Mrs. Thomas is a 24-year old first time mother who comes in for evaluation of low milk supply. The 7 week old baby had gained weight well until the last 2 weeks when the mother noticed less wet diapers and a decrease in volume she was able to pump. Prior to the visit with you, she had been evaluated by a lactation consultant. At a visit 1 week ago, pre- and post-feeding weights showed low transfer of milk, but no nipple trauma. Her son now has a coordinated suck and swallow, asymmetric latch with a wide angle of the jaw. The mother holds the infant in a neutral position with the head slightly extended. The mother had been healthy prior to the pregnancy, had not pregnancy complications and had an unremarkable labor and delivery. Her breast exam was normal.

Mothers Concerns

The baby never seems satisfied unless he is breastfeeding, otherwise, he is crying

Her in-laws, who recently arrived to help with the baby, have encouraged her to stop breastfeeding because he seems so unhappy

She doesn’t think the bay likes her

She isn’t sleeping well

She feels as if she has already failed as a mother

Questions

What factors might contribute to the change in milk supply?

How might you counsel this mother? Her family?

What are some ways to help this mother increase her milk supply?