Jerri,
When a mom is on domperidone, Tom Hale says it creates a steady elevated
level-- there will be little surge with nursing.  So while it can be helpful
to see baseline and spike pre-medication, you will only need a baseline
reading when testing while on domperidone. 

Given the details you've shared, the pituitary is responding appropriately.
I doubt that retained placental tissue is involved at this point, and while
anemia doesn't help and can hurt, it may not be the whole issue either. You
didn't mention what the production deficit was, only that mom was
struggling. Right now the only other red flag I hear is the wide spacing and
long breasts. How do they palpate? 

I have a mom, a co-worker, actually-- who had great breast growth, perfect
health and reproductive history, good pregnancy and delivery-- and whose
milk just never really got going. She was getting maybe 12mls per session.
TSH a perfect 1.0. Prolactin came back low (40ng) at 3-4wks pp so we got
domperidone and that pushed her prolactin up quite a bit, but not much
change-- doubled her output to 22mls. I am stymied and none of the medical
experts I know have any suggestions on where to go with her. Glandular
tissue is great.  I sure wish we knew more.

~Lisa Marasco

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