Tried everything, milk still won't come in

QUESTION: Solomon was born 6 weeks early; so yesterday was his actual due date. I want desperately to breast feed; however, my milk never "let down" and I started the poor thing on a bottle. I used the S & S tubing mechanism to supplement with formula and pumped every 2-3 hours for 2 1/2 weeks but still no let down. I took fenugreek for a week (6 pills daily) but broke out in a terrible rash and was advised to stop taking it. The baby latched on wonderfully and had no other problems at birth; he never left my room. I could hand express some milk to bead up on my nipples but never got anything when I pumped. (It was a nice, double electric pump rented from the hospital.)

I have worked with 4 lactation consultants to no avail. They all said they have no idea why my milk never really came in and have no other suggestions. My sister also had a baby and her milk didn't come in either. She didn't even get milk to appear at all. My sister-in-law who was currently breastfeeding tried desperately to help. She said because milk only would come out in 3-4 places on my breasts that maybe I didn't have enough glands to produce. Is it too late for me to try anything else? My baby isn't too interested in being put on the breast now because he is used to a bottle nipple. I would appreciate any suggestions.

In ten years of working in four different NICUs, I have unfortunately come across a surprising number of moms like you whose milk never seems to come in, or else they just don't let down to the pump at all. There may be several reasons why your milk never seemed to come in, stress being my first choice. At this point, I would wonder about your thyroid levels, as well as your hormone levels. Have you had any unusual or persistent vaginal bleeding? If your uterus has retained a piece of the placenta, that can inhibit the onset of milk production. Most OBs don't think about retained placentas, or agree to check hormone levels; they don't see why moms are so upset about not making milk. This is truly unfortunate. Can you get your OB to check your thyroid and hormone levels? Did you try Reglan? Oxytocin nasal spray? (hard to find) Can you get Solomon to stay on your breast while you use the feeding tube device? If so, I would keep doing that, and just put commercial formula in it. If not you may need to try a nipple shield along with the feeding tube. You will have to meet with a lactation consultant to proceed with all or any of these devices.

Did any of the four Lactation professionals that you saw feel that you had insufficient breast tissue? Have you asked your OB about any of these problems? Most OBs know a lot about breasts, even if they don't know anything about breastfeeding. I'm sorry I can't help you more at this point. But I would recommend going back to the lactation consultant you liked the best and having a long talk with her. Good luck.

Debbie Rabin, OTR, CLC

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