Expert: ruth kraft - 7/15/2009

Question
I have 75 day old twins (born at 26 3/7 weeks gestation) and have been pumping breast milk with a Medela Symphony and Ameda Purely Yours pump since their birth since they were far too little to feed. I had a difficult time establishing my milk supply off the bat and was prescribed motilium 40mg every 6 hours which seemed to help out as I was able to produce 700-900mL/day. For the last 2 weeks I have had 4 incidents of severely blocked ducts. At one point I had to have a milk blister (aka bleb) extracted from my nipple with a needle at the doctor's office. Since the on-set of the plugged duct my milk supply started to diminish and is currently at extremely low levels (I'm not even able to get 400mL/day now#. I am pumping every 3 hours, putting babies to breast 2-3 times each day as their health allows, taking motillium #40mg 4 times daily# and fenugreek #3 capsules, 3 times daily).  My right breast used to be my "good" breast and since my last plugged duct I'm lucky if I can pump 30mL every 3 hours off it it (used to be able to get 60-80mL/pump). It seems to have "deflated" as well, as my breast is now extremely soft (you wouldn't think milk was in there) and is considerably smaller than my left. I'm desperate to keep my milk supply but it seems to be diminishing each day regardless of what I do...PLEASE HELP!

Answer
wow, congrats on getting this far! I am very impressed. also a mother of a preemie that spent time in the nicu its a frustrating and stressful event .... I battled it out too and went on to nurse for almost a year...  So, from where you are, I would suggest starting to pump every 2 hours, maybe every hour and a half. at least for a couple weeks, try drinking mothers milk tea a few times a day instead of the fenugreek, ( the body may have a less of a reaction to it if you have been taking it a while so the switch out might be good ) if not, you can always go back. You can get mothers milk tea at health food stores like whole foods or GNC, I would also check the valves on the pumps you are using. after 4-6 weeks of full time use, the valve ( where the milk flows from the flange into the pump bottle .. the little soft rubbery peice ) often gets weak and needs to be replaced. which makes it much harder to pump effectivly and the suck gets weaker.

Even if your breasts are soft and it seems no milk is in there, I promise it is... if you are getting some milk, you can continue to make more. its supply and demand.  it also seems like because of the clogged ducts your breats are getting a bit frustrated, maybe thats why the milk is not as plentiful... SO, what I suggest for the next couple weeks, is put warm compresses on your breasts while you pump or right before,  and then when you remove the wash clothes, massage downward towards your nipple while the pump is on. its not easybut eventually the coordination works :) make sure you massage around your whole breast starting at the furthest breast area from your nipple going down toward the nipple and spend a little extra time where you have gotten the clogged ducts previously. this will help ensure they dont become clogged and encourage them to move a little more freely as you build up this milk..

Good luck! its alot of work, but its so satisfying to know your preemie does well all because of you :)

Ruth kraft
www. honoringwomen.com