Hello,
I have to admit, I rarely post and often if I am in a rut, I can come here and 
search the archives and find my answers from more experienced ones.  Well, 
I'm really in a rut now and feel very sad for women who want to breastfeed 
and for whatever reason, their' bodies just don't respond.  

I have a VNA patient that I have seen for about 6 weeks now.  She 
apparently got off to a rough start, had a prodromal labor and was so 
exhausted and uncomfortable immediately postpartum, that admitedly she was 
not putting baby to breast enough.  So, by the time I saw her (about 1 week 
postpartum), she was soft and had very little milk.  

The good news, her baby was a bruiser and a baracuda at the breast, so no 
problems there.  He was doing great and loved to nurse, however becoming  
frustrated after what little milk she had ran dry.  She had started 
supplementing, as directed and we started my typical routine with this type of 
case and had her start pumping after each feeding and finishing at the breast 
method when he became impatient.  She was reluctant to use an SNS, so 
although they were a perfect candidate, never did do that.  I gave nurses 
orders for them to do nothing but breastfeed and pump until she noticed an 
increase in milk and a decrease in supplement.  I thought for sure the baby 
would do all the work.

Well, after a few days, no change.  She admitted not pumping as often as I 
had directed, although, she was pumping a minimum of 4-6 times per day and 
nursing him constantly.  So, she started fenugreek.  She was at the time on 
lovenox and was a bit nervous about other herbals, so we started with 
fenugreek and waited a few more days. 

Four days later, no change.  At most, he was transferring 1 oz at a feeding 
and his supplements were increasing.  Which by the way, he has had every 
sensitivity.  He has been on everything from soy to nutramagin.  So, I spoke 
with her OB and she started her on Reglan.  I thought for sure this would 
make the difference.  Ten days into Reglan, still pumping, finishing at the 
breast until satisfied with supplements, breast compression, hand expression, 
the whole bit, no change.  

She was off lovenox and we switched her to Mother's Love more milk plus.  
It's been 10 days with no change.  

I have discussed with her having blood work done to test hormone levels and 
thyroid, etc.  Am I missing something?  Forgetting something?  Can we try 
something else.  She is feeling like breastfeeding is just not in the cards for 
her.  I am very sad and want this to work for her and her baby.  

I appreciate any input you can give.  I will be seeing her this week and want 
our visit to be optimistic and encouraging.

Thank you!
Laura 

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