Dear all:
 
We are hoping to get some advice regarding one of our clients, who is
expecting her third child any day now.  I have mom's permission to post.
She is optimistically hopeful that she will be able to bring in a full
supply with this baby, but is also worried that her previous low milk
production will be repeated.  We have been totally stumped as to why her
supply has been so low.  Both previous children were born full-term, and
well.  No separation of mom and babies, and babies had unlimited access
to the breast in the first few days of life.  Due to low supply concerns
with the first, mom also started fenugreek and domperidone almost
immediately with the second baby, and between feed pumping to further
boost production.  Mom has no apparent risk factors for not making milk.
No difficulty getting pregnant or maintaining pregnancies.  Regular
menses since onset of menses, no thyroid issues, no diabetes, has normal
breast development, no hx of breast surgery.  No unresolved engorgement
post-partum with previous children, no scheduling of feeds.  With both
children, production, as determined from weekly weight checks and
clinical ac/pc weight checks, and pc pumping, was about 30-40ml/feed,
from birth until mom stopped coming in at 6 weeks post-partum.   This
mom is pretty committed to working on this for 6 weeks, but thereafter
will likely switch to ABM if low milk production occurs again.  Even
though we have talked about defining her own success, she really would
like this to be all or nothing.  Lactation device has been tried in the
past, but this mom found it difficult to use.  As this mom left our
clinic for the last time with her previous child, one of the clinic
volunteers made a comment that this mom has a somewhat masculine build
(tall and broad-shouldered), but otherwise features are very feminine.
This comment stuck with me, and, especially after the recent study from
Norway and high levels of testosterone in some mothers, I am wondering
if this is something we should investigate with this mother.
Post-partum blood work is something we did not do in the previous two
breastfeeding experiences.  
My questions are:  Should we "wait and see" what milk production will
be, or should we do blood work immediately?  What blood work should be
included? (thyroid function, testosterone levels, prolactin levels?)  If
the previous low milk supply situations were perhaps due to an
undiagnosed, asymptomatic theca lutein cyst, what are the chances of
that happening more than once?  If blood work were to reveal higher than
normal testosterone levels, can anything be done about that?
 
Hopefully someone has had a situation like this, that may be able to
provide some assistance.  As this mom herself works with babies and
mothers, it is important for many reasons that breastfeeding is a
successful experience.  
  
Thanks in advance,
Doreen Vanderstoep, Ontario, Canada

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