I have a 30 year old mom who had a c section for failure to progress (8 lb 11 oz baby and a 5 ft tall mom). Infant was in special care and NPO for about 24 hours. apgars were 5/6/8, Mom started expressing soon after delivery and had 2 ml, 7 ml, 3 ml colostrum for infant prior to starting to breastfeed. Infant weight loss in hospital was minimal (.3%) -she received a few small formula feeds in special care and IV fluids. At discharge, about 72 hour post delivery, infant had been "cluster feeding" per mom all night and had no formula for 24 hours. I observed breasts soft, an eager baby, good latch, no swallowing, and no milk present with hand expression or pumping-not even a drop. I suggested small formula supplements after breastfeeding, continuing on demand. I set up appointment to see them next day. .

I saw her next day- Infant was at 5% weight loss (6 oz  drop in 24036 hours), she had BF about 15 times in 24 hours and gave 20ml formula. Breasts still same as at d/c. No milk visible with hand expression or pumping. Infant was very hungry but would latch well and just suckle. I started her on the SNS and had her pump and hand express for stimulation.

Her history: Postpartum hemorrhage, transfused 2 units PRBC, discharged with H&H of 7.5/22.5 and on Iron supplements. I gave her handout on Iron rich foods and suggested these in addition to Fe supplements. Normal large breast anatomy, normal breast increase in size and tenderness in pregnancy, no leaking, not obese, average weight for height, no fertility issues.

At 7 days postpartum- She had gained 2 oz in 3 days with BF and formula. I am still unable to see any sign of milk. She had lost a part to the SNS so switched to bottlefeeding the formula and she pumped a few times in the previous 2 days. I got an order for Reglan for her. I suggested exclusive pumping x 24 hours and lots of skin to skin, then to return to the SNS. She will follow up with me after 2 days on Reglan.

The anemia is the only thing that I can pinpoint to cause the milk issue. I'm aware of Sheehan's syndrome but do not have experience with it. 

What lab tests should be ordered on mom and are there any suggestions from the group? Looks pretty grim but she really wants to breastfeed. 

Kris Nilson BSN RN IBCLC

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