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.
Mom's breasfeeding history is as follows:
#1, girl, breastfed excl. for 1 month, w/suppl ABM to 5 months
#2, boy, breastfed for 1 month, stopped due to sore nipples
with #1 &2, milk "came in classically"
#3, boy, never (?) breastfed, jaundice, fever, dehydration, hospitalized
under bili-lights
#4, boy, supp'd with spoon or cup for first 2 weeks, then breastfed for
18 months, until 5 months into pregnancy #5
(When she reduced # of feeds to 3/day, she "lost her milk", but bb
continued to nurse for comfort)
with #3 &4, no significant breast changes were observed during pregnancy, and
no dramatic "milk coming in"
#5, boy, supp'd from day one, tried to pump with Lactina Select double
pump, never got more than 1/2 ounce total. Supp'd with soy formula, (her
choice). Her MD would not approve more than 1 week of Reglan, concerned about
effects on the baby. Mom was not receptive to domperidone, and especially did
not want to consider any herbs. She still feels the same way with #6.
Her thyroid levels were fine the last time they were checked. Sorry this is
so long, but I feel the need for wiser heads.
This mom really wants to breastfeed, and she also is aware that this baby
needs adequate feeding.
Thanks for any input,
Beth Sargent, IBCLC
Needham, MA, USA
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