Riva asks for input about a case of a mother of twins who was initially not encouraged to breastfeed and is trying to do so anyway.  I agree with the other two who have responded, that doing hormone tests would not be helpful at this point.  After reading Riva's post I found that the plan she is already using, is what would be my first, second, third and fourth choices for how to go on: support the mother to have the babies at breast, follow her as her milk supply builds up, and I am quite confident it will do so, since she is able to express as much as 30 ml already, after 11 days of hardly breastfeeding or expressing at all.
So, in answer to Riva's questions:
'Are there any other tests she should do?'  IMO, not at this point. Maybe (BIG maybe) later, if the normal things don't help - but even then, what are the tests going to tell her that she doesn't already know?  If the breastfeeding doesn't go well, will it help her to know what her hormone levels are?
'What should I be looking for in the prolactin level test?'  Nobody really knows, so don't do it.
'How much can motilium help in cases of hypoplasia and hormone imbalance?'  I don't know, and I am not convinced that this mother has hypoplasia or a hormone imbalance anyway.  Again, see how the normal things help first.
'She is interested in using an SNS - would that be appropriate in such a case?'  An SNS could be very appropriate in this case, to keep babies at breast.  Since the mother is interested in using one, I would help her find one and show her how to use it, and let her know that if she finds it too fiddly, she can still breastfeed!
'Am I being over optimistic that she can give at least partial breastfeeding?'  Not at all. Actually, I think perhaps Riva is being too pessimistic to think that she may *only* be able to partially breastfeed, but I am not sure I would tell the mother, because she might feel it as pressure to exclusively breastfeed and it might not be possible. It's difficult to make predictions, and especially about the future, as my husband's grandmother used to say.  The only thing we know for sure is that if she doesn't keep going, the breastfeeding definitely will stop.  Nobody knows how much she will be able to produce. She carried twins to term and her breasts are working as well as can be expected given the unfortunate start.   

I want especially to commend Riva for this part of the plan:
"I am trying to keep her optimistic and spend as much time sts with the tiny girls and she seems much happier that someone is believing in what she thought should be true.'

The key part is that the mother seems much happier. Three cheers for that.  I hope we will be able to hear how this goes, because IME if such a mother is supported well, she can breastfeed for a long time and really enrich her time with her babies besides. 

Rachel Myr
Kristiansand, Norway

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