I got a call from a mom tonight very upset because she is convinced that her
supply has suddenly diminished to almost nothing.  (She gave me permission
to post.

Mom is 30 yo and otherwise healthy.  Baby is 5 months old.  First baby.
Conceived with fertility meds, pregnancy complicated by pre-term delivery at
36 wks.  Baby in NICU for one week and went home nursing well.  Mom pumped a
lot during the brief NICU stay and had such an abundant supply that she
ended up throwing a lot of her unused frozen milk out a couple of months
ago.  She's been nursing on demand and baby has been thriving.  Started
solids relatively early at 3 months (2 months ago).  Baby gets cereal mixed
with EBM in am and a fruit or veggie at dinner.

Two days ago Mom noted a huge drop in her supply.  Says she can no longer
hear baby gulping and no longer feels any sense of engorgement or letdown as
before.  Until now she had been pumping every couple of days to get EBM to
mix with cereal and used to get several ounces easily.  Now she has a hard
time getting even a few drops.  Baby used to nurse every 2-4 hours during
for "three" minutes each nursing during the day and sleep longer at night
between feedings.  Now baby is still nursing every 3 hours or so during the
day, but wants to stay at the breast much longer (up to an hour at a time).
Woke every hour overnight last night to feed.  Mom notes that diapers are
definitely not as wet.

Mom's intake (food and drink) has not changed at all.  No OCP's.  No new
stresses at home.  Returned from a trip to California (from New York) last
week, but otherwise nothing unusual going on.  No new meds in mom or baby.
Baby saw the peds MD 5 days ago for a URI and did not receive Abx.  Mom has
not had return of menses yet and is 100% sure that she is not pregnant.  Mom
called the Ped yeseterday re. the decrease supply and was told to try to
pump and to start formula every 3 hours from a bottle, but that they didn't
need to see the baby for weight check, etc. (sigh)  Baby is adamently
refusing the bottle, mom has tried a sippy without success.  Husband is
supportive. Other than feeling stressed and depressed about her milk supply,
mom feels well.

She has only one bottle of frozen EBM left, and is devastated.  She really
wanted an extended breastfeeding relationship. She is going to try offering
the breast more frequently during the day, and to increase solids (banana,
etc) a bit.

Any thoughts or suggestions?  Mom sounds really motivated, and very
concerned.  It seems a bit strange to me that the baby is not asking to
nurse more frequently during the day.  She's going to consider obtaining pre
and post-feeding weights of the infant to see how much he is actually
getting. But I definitely get the feeling this is more than.  Would
Domperidone or another galactogue be worth trying?

Thanks so much in advance for your input!

Jayne R. Charlamb, MD, LLLL
Syracuse, New York

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