Hi everyone,
    Posting to request help with mom's permission.  Baby is 6 weeks old, delivered 2 weeks early via c/s due to placental abruption (partial, no Sheehans).  I have asked about bleeding and mom says she is no longer bleeding at all, had normal course after delivery & feels sure that placenta was completely removed.  Mom had no cup size increase and minimal breast changes during pregnancy, no engorgement or feeling of the ususal milk coming in fullness.  Breasts are very soft and "squishy", no major size discrepancies or overly large space between them.  Mom got pregnant easily, hgas no other signs of PCOS.  Mom has lost 27 lbs since delivery.  Tried Fenugreek & Blessed Thistle tinctures for 3-4 weeks w/out improvement, for the last week has tried Domperidone 20 mg 3-4x/day, but supply has continued to decrease.  Mom has never pumped more than about 75 cc total from both breasts, now is getting usually 10-30cc.   Baby has variety of issues in terms of suck pattern, poor latch, trouble staying awake at breast, etc., so mom has been pumping 7-9 times/day w/ Lactina, continued putting baby to breast at each feed,  and has recently begun using SNS, which helps but baby still only transfers about 35ml from the SNS and I am  not sure she is getting much of any transfer from breast .  I have asked mom to get thyroid checked, and suggested increasing the Domperidone, possibly adding Goat's Rue, or using the Mother's Milk Plus. Also adjusted settings on the Lactina to a more workable level.   Have BASICALLY ruled out retained placental fragments based on history mom gives, but wondering what else to try????  Also wondering what you all think of her chances at this point, 6 weeks postpartum, of getting even a better partial supply??? This mom has been working SOO hard....any ideas greatly appreciated!!!  I am wondering what other hormonal or physiological factors I might be missing..... TIA for any help!!!!!!!!!!!!!
   Esther Friedman, IBCLC

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