Hi, all---
I'm hoping that someone out there can help fill in the blank here. I just saw
a mother whom a student LC brought in for additional help. This is mom's
second baby, now 10 days old; with her first, she went into labor at 40 wks,
decels were detected at admission, and an emergency c-sec was performed. 1st
baby was IUGR; BW was same as ultrasound weight a month previously, placenta
severely deteriorated, cord short and thin. Mom had developed a *lot* of
edema though she never became toxemic, and doctors told her it was hereditary
and would likely recur with next pg.  Once baby was stabilized mom initiated
bfg, but after a few days the baby had lost more than 1 lb, > 10%.  Mom's
milk had come in so slowly that she wasn't really aware of it, and she gave
up bfg very quickly.

Now we have baby #2.  Mom again developed severe edema with some numbness of
extremities.  Weekly ultrasounds were undertaken, and when mom began to
experience blurred vision, baby was delivered caesarean at 36.5 wks, 6 lbs 12
oz. Mom initiated bfg a few hrs after surgery, baby was very sleepy at first
but she felt that he did *much* better than her daughter had.  D/C wt was
6-2oz at 3 days, and at 5 days baby was 5-13.  Baby had not had a stool in a
few days, but since floor nurse told her that breastfed babies may only poop
every 2-3 days, mom didn't flag it (boy, do we need some straightening out
here!).  Baby was nursing every 3-4 hrs.

Student LC did the 5-13 wt.  Observed mother feeding, did pre- and post-feed
wts, intake only 5 cc after 15 min bfg w/o much audible swallowing at each
breast. Single pumped both breasts, obtained 8cc more. Mother had felt that
her milk had started to come in the day before, and drops were white, but not
copious. Mom was started on pumping regime and fed that milk plus ABM
supplement to baby via bottle.

Today baby was 6-7; L-O well, fed 15 min ea breast for test wt of 48cc. Mom
had not pumped in 4 hrs.   According to mom's records, her supply has gone
from almost nil to about 8 oz a day, about half what she needs.  With
appropriate continued stim, I think that she should be able to get that
supply up all the way. Mom has been feeding 8-10 times a day but pumping more
around 6.

I screened her for fertility, hormonal, etc. issues.  She is slightly low on
progesterone, miscarried twice, carried one to term w/o help, had
progesterone shots w/this one; good breast growth. Blood was drawn yesterday
for prolactin baseline, but results not yet in.  Since I saw evidence of MER,
I do not see let-down as an issue. No "labor" drugs, only spinal w/durimorf
for delivery (epidural w/ first baby) and T#3 + metoclopramide for
post-surgical pain (mom doesn't handle codeine well).  Mom reports having
lost 30 lbs of water since discharge from the hospital one week ago, and she
still has very noticeable edema of hands, feet, body, and some continued
numbness in her hands that were a problem in holding baby while bfg. No
diuretics are to be tried until after 1 mo pp.

SO------ it's back to that swelling. We've talked a lot about pitocin, edema,
delayed lactogenesis; this doesn't fit our discussions exactly, but I am
highly suspicious here of a correlation.  I think that good management will
bring the mom up to standard, but we all want to know the "why" of her
troubles.  Can some of you "experts" help in this question?

TIA,
Lisa Marasco, LLLL, IBCLC
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