I would like to commend this lady for her committment and efforts to
breastfeed her children. If mother has worked with several consultants, what
does the examination of her breasts reveal? Even though I don't say anything
right away to a mother,  I am virtually always right in predicting mothers
who will struggle with milk supply, just by the the look and feel of the
breasts. Typically, the breasts are quite flaccid in the early days, and
then "fill" somewhat mostly towards the areola.
For the mother in question, I think I would put her in touch with an
herbalist and see what herbal tincture she could start using right now. Then
I would recommend that she continue (with possibly a different combination
of) herbs after the birth, and / or prescription galactagogue, and I would
encourage her to breastfeed with a supply line very early on. If she has
access to donor milk, she should arrange that now. If not, I would advise an
elemental formula if affordable, or a standard cow's milk formula if
budgetary constraints. I would not recommend pumping.
All the usual good bf practices, of course, should be facilitated.
Laurie Wheeler RN MN IBCLC
Mississippi USA

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