Hello Katherine,
Your assessment is very thorough!!  The only other things that come to mind (that you've probably already ruled out) are postpartum hemorrhage and whether her breast pump is new or used?  Also, I wonder if her "dense breast tissue" is glandular tissue or fibrocystic disease?  
Amy Wagner, BS, RN, CCES, IBCLC

Sent from my iPad

> On Oct 20, 2016, at 10:42 AM, Katherine Morrison <[log in to unmask]> wrote:
> 
> Dear Lactnetters,
> 
> I have permission to post. This moms supply is disappearing and I need your
> help.
> 
> Mom: 31 yo. G1P1. normal/BMI, no infertility, symmetrical, full breast
> development, breast changes during pregnancy, no hx hypothyroid, no
> menstrual irregularities, no hx iron deficiency, no hx surgery etc). Very
> fit, very healthy. Very sweet. Husband is equally awesome, loving,
> supportive. Great family support - just a sweet, sweet family.
> 
> Full term, male infant, vigorous, healthy, no health concerns. Bubble
> palate. PTT.
> 
> ***Labor 27 incl 5h pushing.****
> 
> Baby nursed well from the start. Nipple lacerations (in spite of deep
> latch) within 24h due to restricted oral tissues, bubble palate, moms very
> dense breast tissue (almost as if she has implants but she does not).
> 
> They called me day 5 due to nipple pain, positioning challenges, 10% weight
> loss (for which the ped did not recommend supplementation; just "call a
> lactation consultant")
> 
> Mom is currently exclusively pumping while we await revision. aby is being
> bottlefed (paced, very upright, active latch; dr brown's preemie nipple)
> and nursed by her two sisters as well.
> 
> Mom began experiencing engorgement on day 6 - yes, day six. Slowly her milk
> increased to a max of 8 oz/day (pumping 120-140m per day no less than every
> three hours, sometimes more frequently to mimic cluster feeding).
> 
> She is using an Ameda Platinum pump with properly fitted flanges (22.5 mm,
> nipples the size of pencil eraser....22.5 might even be too big. 25 mm was
> huge, pulled areola into flange and caused swelling and blanching)
> 
> Hands on pumping, breast massage etc. Sisters are helping and the whole
> thing is just amazing.
> 
> She's cuddling baby a lot, plenty of skin to skin, basically staying in bed
> wearing panties. Revels in his his existence.
> 
> And her milk is drying up. Today, she is pumping a quarter of what she
> pumped Tuesday and Wednesday (8 oz total per day)
> 
> No unusual bleeding, cramping, clotting. She is only having to change her
> pad once a day....which made me wonder (at 10d pp).
> 
> This OB is generally resistant to u/s for retained fragments and resistant
> to blood work.
> 
> I did speak to the mw who attended the birth and she feels confident that
> there are no retained fragments.
> 
> Thoughts and suggestions?
> 
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