I'm have a client who is nursing her 4th baby.  She breastfeeding the first 2
with no problems.  Then, she had implants inserted under the arm and under
the muscle.  The implants did not drop, so they were removed and incision was
made on the underside (6 o'clock) of breast and implants placed under the
muscle.  Baby number 3 had weight gain problems, but mom had lots of stress
moving from TX to FL and baby had a poor suck. She worked hard at her supply
taking herbs, domperidone and pumping for many months to give him as much
milk as possible.

Fourth baby is now a month old and she has been struggling since the baby was
about two weeks.  She saw me right away after this baby was born.  Lots of
milk and baby transferred well.  A week or so later, she came in to weigh
baby and baby was gaining slowly (about 1/2 per day), did test weight,
transferred well.  Called me the following Sunday, baby was crying and
pulling and tugging at breast as if not getting any milk.  Mom became
exasperated and gave formula after trying to pump and only getting drops.  On
Monday, mom was engorged and running a 105 fever with mastitis.  When the
mastitis cleared, she felt the baby was not emptying her breast and she
rented a baby weigh scale from the hospital lactation center. Between pumping
and test weigh, she has decided that her MER is erratic.  We can't seem to
find the cause of why it will letdown sometimes and not others.

She is presently taking domperidone, feeding at breast, then emptying breast
with pump unless she has a good letdown when nursing baby.  This has been the
most perplexing case. The mom and I can't seem to find any common factors as
to why at sometimes she will letdown and not at other feedings.

She was in the office today and I tried Rescue Remedy, still no MER.  Good
latch, doing breast massage and compressions.  Mom says she is relaxed and
has no stress.  She looks relaxed.  Any suggestions????

Warm regards,
Pat Lindsey, IBCLC - Lactation Services  www.PatLC.com
Pediatrics Plus' Lactation Consultant   www.pedsplus.com

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