Beth,
I haven't seen any replies to your post.  I was hoping to gather knowledge
on this situation from all the wisdom available on the list.  I am not (yet)
an IBCLC, I'm sitting the exam this summer.  My study partner and I have
just been reading about hormonal influences on breastfeeding, so this was
very timely.  I have some thoughts, and lots of questions.  I'd love to hear
from the more experienced of you out there.

You don't mention exactly when her prolactin level was tested (pre- or
post-birth) although this level seems very low for either if it was within a
few days of the delivery.
Has pituitary function been evaluated?
Did she experience a great deal of blood loss with the delivery?
Could she have retained any placental fragments?
Was this a full term delivery?
Is baby going to the breast at all?
Is the mother a smoker?
Does she have high levels of dopamine or taking medications mimicking
dopamine?
How does the mother feel about this pregnancy/birth in general (i.e.
stressed, thrilled....)?

At three days I wouldn't be terribly concerned that her milk has not come in
yet, but I would certainly be trying to get colostrum into the babe.  Am I
off base here? -- day 3 seems really early to begin supplementing to me.
My understanding, and observation in working with breastfeeding mothers is
that with subsequent pregnancies breast changes may be minimal and unnoticed
by the mother as the internal structures have been laid down and "exercised"
by previous pregnancies and breastfeeding experiences.  I would imagine this
is especially true with episodes of lactation occurring so closely spaced.

Comments welcome.

Dawn Martin
Austin, TX
IBCLC wanna be and acutely aware of how much I don't know.

----- Original Message -----

> I am working with a mother who has just given birth to her sixth child (in
> nine years). She has been told that her prolactin level at term was
8ng/ml. I
> know the range at term, according to Lawrence, should be 200-500 ng/ml.
Her
> baby girl is now 3 days old, has had only one wet diaper in the last 24
> hours, and one "big" BM. They are already supp'ing with ABM. Bb is
> jaundiced--don't know the bili level, but sclera are clear and face &
upper
> trunk are yellow. She's putting the baby in sunlight as much as possible.

> This mom really wants to breastfeed, and she also is aware that this baby
> needs adequate feeding.
>
> Beth Sargent, IBCLC

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