Possible letdown/oxytocin malfunction?
Holly McSpadden, IBCLC
>>> "Jaye Simpson, IBCLC" <[log in to unmask]> 8/12/2012 11:13:14 PM >>>
Hi all,
PTP:
Mom is 36, has (fraternal) twin sister who has had exact same
symptoms/problems re: milk supply with her baby. Their Mother had a great
supply for them as babies nursed for 6 months.
Mom is currently 9 days pp. Baby has structural issues and is unable to
breastfeed well at all. Mom is nursing for comfort, and using Symphony
pump. I tested the pump, evaluated flange fit all is fine there. Mom has
nice veining on breasts and absolutely no signs of IGT. Breasts grew a full
cup size during pregnancy (with both babies she is having a repeat of
supply issues with 2nd baby). She experienced her milk coming in on day 3
4 with extreme fullness but never pumped more than drops at that time even
with pumping q. 2 hrs. Mom started fenugreek 3 caps (610mg ea) 3 times per
day. By day 6 was pumping no more than ½ - 1 oz q 2 2.5 hrs around the
clock. And that is where she is today.
We did blood work: Thyroid, prolactin, and iron - ALL is absolutely FINE.
The only hormone I am unsure of is testosterone which came in at 32 (range
14 76) but I dont know what a lactating moms testosterone levels
should be and cannot find any information on that. Dr (thankfully) is
willing to rule out retained placenta with ultrasound but moms prolactin
levels are high (180.3, day 7 pp, not sure if before or after pumping) so I
am thinking retained placenta is not the issue and Dr checked her bleeding
and said all is normal there.
Moms labor and delivery were uncomplicated and . Baby born full term. Mom
on IV Fluids for approximately 15 hours, given Pitocin at lowest levels for
approx. 10 hours, then an (light Anesths words) Epidural for approximately
6 hours 1 bolus and then a 2nd dose just before delivery when they
increased the Pit and then 30 min later, after 10 min. of pushing baby was
born. Epidural had Fentanyl.
Mom busted her butt with last baby taking herbs and pumping like a mad-woman
(q 2 hrs around the clock) with no more than 2 oz MAX able to be pumped and
only once in a while (typically in the morning). She did this for 6 months
before quitting. She is clearly looking at the same situation this time.
I am at a loss. Everything points to the fact that she should have milk and
lots of it. No other medications are being taken, no other complications
I did the Assessing for Insufficient Milk Supply a la Lisa Marasco and
nothing. Everything points to being just fine. I have her contacting her
mother to see if mom took any medications during pregnancy with her twin
daughters since both women have had the same problem. My client has done
everything by the book right to ensure no mismanagement and the best
possible outcome, she has no history of abuse, hormonal issues, no signs of
hormonal issues, got pregnant very easily, is on no medications (now or
during pregnancy), no history of breast surgeries or injuries of any kind.
In my nearly 18 yrs I have only had one other case where it all looked
perfect, all the tests, and everything but still very little milk.
Thoughts?
Thank you!
Jaye Simpson, CLE, IBCLC, CIIM, MoM
Breastfeeding Network
www.breastfeedingnetwork.net
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