Just when I had decided to go nomail for a while and a much needed rest,
here is a case that has me stumped. I already searched the archives, but
would need your collective wisdom to put it all together:

Mother is a nurse, has her fourth child. Breastfed "successfully" her three
others. The quotation marks are there because the babies were not gaining
weight too too well, but there was no immediate danger to their health,
and Mom weaned on her own accord at 4-5 months. Now, it is important to
say that these three episodes took place with breast implants.

Divorce, takes the breast implants off, remarriage, fourth baby.
Unmedicated delivery, but baby is hospitalized for dehydration at day
four, while Mom has an "enormous" engorgement. Rents a pump and expresses
2 ounces in the first sitting, then a little bit at a time. Baby comes
back home, Mom sees an LC (certified) and does everything well,
supplementing with finger feeding and bottle occasionnally, the LC not
convinced that confusion exists. From day 1, baby not vigorous on the
breast. Seems to have taken the breast better on weeks 5 and 6, but
rapidly seems to not have enough, and is jittery on the breast.
Now, baby is 2 and a half months, she is pumping every 2 hours for 10-15
min. at a time, after each feed or just about, baby is on the breast only
all night long, one side after the other, and still needs about 6 ounces
of supplementation with formula. We started domperidone (motilium) 4 days
ago, with no change whatsoever. The lactation aid is now the only
supplementation method, but does not work so well: baby takes the breast
when the bottle is squeezed and he feels milk in his mouth (he also still
does not latch on well, waiting for the milk to come, and suckling
lazily) She feels the ejection reflex, but
sees very little squirting from either breast. I asked for a TSH, but,
frankly, I wonder if the removal of the breast implants did not severe
breast tissue... Her surgeon says no... What do you all think ? What else
could we do ? How long does Domperidone take to work ? (my experience
with it has not given spectacular results, but is also quite limited). Is
there hope for complete breastfeeding ?

Louise Denhez, M.D., M.P.H
Montreal, Quebec, Canada