i am working with a first time mom of a 4 week old baby. she has a history
of thyroid problems (unclear exactly what, but she is on several meds).
after birth of baby, no problems with weight gain or breastfeeding for a
bout a week, then a sudden "dissapearance" of her let-down. she consulted
an ibclc (miriam - you out there?) and ibclc confirmed latch, suck good,
but milk not letting down - no apparent reason why. she began pumping and
easily pumped enough milk for her baby to gain 11 ounces that week and 8
the following 4-5 days - so no apparent problem with milk supply, even
thought the thyroid meds may not have completely leveled her hormones to
the right point yet. her obgyn prescribed reglan at recommendation of
hopsital based ibclc, and she took it for a week - after a couple days of
this, the let-down problem seemed to have subsided and baby exclusively
nurisng at breast - no pumping, no supplementing. mom and baby are also
battling thrush - mom given 1 single dose of diflucan (not sure of mgs.)
and nystatin for baby. after i gave her info on gentian violet seh started
that, (day 3 now) and is considering asking the pediatrician who prescribed
the diflucan for the full 2 week course with loading dose per jack newman
info.
after a week on the reglan, she was noticing deppresive effects, and
feeling more confident with her supply, and chose to discontinue it. it
seemed fine for a day, but seh woke up this morning with same problem - no
let-down to baby, but pumped 4 ounces off one side in jsut a short time.
she will probably re-start the reglan, but she is panicking about her
ability to feed this baby.
i could use input on a couple points:
1) is there a relationship between reglan and let-down reflex, when supply
seems fine without reglan?
2) is there a relationship between thyroid disorders nad let-down reflex
when the milk supply seems fine?
3) if her let-down is inhibited - why could that be, and what could help -
i have seen refernece to rescue remedy before each nursing - anyone have
the doseage? might this be a permanent problem for her? could it just be
anxiety over her supply related to her thyroid function, when no supply
problem really exists? does thyroid regulate oxytocin as well as prolactin?
4) in your opinions, should she continue with the reglan for two weeks (the
duration of hte prescription) then stop, taper off slowly starting now, or
discontinue altogether and pursue some other remedy?
5) how superior is domperidone for this situation?
6) could this mom call jack newman for a consult? do you do phone or email
consults?
thanks in advance!
any and all bits of advice more than welcome.
Lyla Wolfenstein
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