Rachel makes an excellent point when she reminds us to distinguish between
infertility caused by probs. caused by issues other than hormonal imbalance.
It is only the hormonal issues that are red flags.  I have a woman with
twins who was infertile due to Polycystic Ovarian Syndrome.  PCOS has been a
factor in some other women with low supplies that I have worked with in the
past.  I saw the twins last Fri. and both had lost a lot of weight.  They
neither took in much directly at breast (1 and 3 ml respectively) even when
well positioned and fed individually.  They are 37 weeks, and sleepy and
small.  They close their eyes and doze at breast even with deep breast
compression and constant stimulation.  Mom experienced a few brief hours of
breast fullness on Day 4.  On Hill and Humenick's self-reporting scale (1=
soft, no changes, and 6= very firm, very tender) this mom was briefly a 3.
Her breasts were soft by the next day, and when I saw her on Day 7 they were
still soft.  I suggested she begin aggressive pumping and spend less time
nursing, as babies weren't really stimulating the breasts or obtaining much
milk.  I spoke with her yest. after 3 days of q3hr pumping.  She is only
obtaining scant drops of milk.  Her breasts are slightly wide spaced, but
they have a rounded contour.  I agree with Cathy Genna that mothers know
when something isn't working in their bodies.  I didn't mention much about
the PCOS on Fri. preferring not to create anxiety.  I hoped the pumping
would produce better response.  I did mention my concerns to the MD in the
LC report however.  Yest, I told the mother that I have some concerns about
her hormonal problems, and she said "I've been worrying about that myself,
because my family doctor mentioned to me several years ago that I have a
prolactin problem. " An MRI was done.  The mom couldn't recall other
details, but I suggested she contact the MD for information on the
specifics.  In the meantime, I've suggested she call her OB to discuss
Reglan.

My hope is that with a jump-start from some prolactin stimulating drugs and
lots of breast stimulation, this mother may bring in some milk.  But
evaluation of the mother's health and hormonal status has to be part of what
an LC considers when evaluating low milk supply and poorly gaining infants.

Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates, Austin, Texas
http://www.lactnews.com

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