>>So, my question: Does this qualify as possible/probable PCOS with low
milk due to hormonal imbalance? And if so, do your current
recommendations involve metformin, goat's rue, and maybe domperidone? I
don't even know yet if galactogogues will be necessary, because I
haven't gotten a chance yet to evaluate the baby's latch or the mother's
breastfeeding behaviors (responsiveness to cues, frequency of
feedings).<<
Elise, you don't actually have to have a diagnosis of PCOS to know that
there are red flags for hormonal problems with this mom. If you did have
a diagnosis of PCOS, it would probably include some known hormonal
aberrations, which would be helpful.
What needs to happen first, of course, is for you to see this mom, take
a thorough maternal health history and infant breastfeeding history,
assess mom's breasts for development, and preferably do a test-weight
feeding to quantify how much milk is really going into baby at this
point. It might also be helpful to have mom find out if her doctors ever
had a tentative diagnosis for her irregular cycles and cysts. Depending
on the outcome of the assessment, metformin may be appropriate if PCOS
is a factor. Extra pumping is always helpful, though it must be balanced
with the time mom spends feeding. I do also often favor galactogogues to
help "turbo charge" the system, but which one(s) depends on the
individual assessment.
I am surprised to hear that this baby sometimes spits up when it is 6oz
under birth weight at 2 wks-- that is unusual in my experience, and I
wonder if it is more a result of food sensitivities in mom's diet, given
that baby has had strong reactions to formulas. I would not take the
presence of spitting up in this situation to imply significant milk
intake. The test-feed should give a good picture. Though it could be a
problem on baby's side (do a good oral anatomy and suck assessment), it
sounds like it will mainly be on mom's side.
If this baby is truly strongly allergic to formula, this is one of those
crucial situations where you desperately want to be able to fix things.
I would probably be aggressive in the care plan, including the use of
galactogogues, to try to bring supply up as quickly as possible.
Lisa Marasco
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