Hi!  I'll introduce myself another time but suffice it to say that I am a
student lactation consultant in the BSC course and a pediatric dietitian at
Children's Hospital of Phila.  I've been lurking for awhile, but now I have a
problem with a mom who I'm counseling and I need input from those with more
experience.

This mother has a three week old baby who is not gaining any weight.  Birth
wt: 7 lb 13 oz.  He has been at 7 lb 3 oz since discharge.  There were many
problems with latch-on initially and a very lethargic baby which I attributed
to her difficult labor and medications (demerol and epidural).  However, the
baby is now sucking well for many hours a day but is still irritable and
sleepy.  There are plenty of wet diapers.

At last week's check-up there was still no weight gain and PMD says to give
1-2 oz. formula per day and return in one week for weight check.

Mom called me early this morning to say that the baby slept 6 hours last
night and when she woke up her breasts were not the least bit full. She tried
to pump from the right breast and nothing came out!  She did get some runny,
clear fluid (foremilk?) out of the left breast, but after twenty minutes
pumping she only got one ounce.

This mom had a very hard time getting pregnant and was treated with pergonal
and HCG.   She had no difficulty carrying the pregnancy to term (no
medication needed), but her labor did not progress and she did not dilate
until a pitocin drip was started.  She experienced only minimal breast
changes during pregnancy and immediately after delivery.  She never had any
engorgement, leaking or signs of let-down.  Mom wants to know if all this is
related to some hormonal deficiency.   I suspect lack of developement of
alveolar tissue and a true inability to successfully lactate.  She is going
to discuss this with her fertility MD tomorrow.

Has anyone ever seen this before?  Is there any hope for her to be able to
produce enough milk for this baby?

TIA.       Rachelle Lessen, R.D.  (soon to be IBCLC, hopefully)