Janna,
1. If she can pump nearly as much after a feed as baby got, could be
partly a transfer problem. Has she tried breast compression?
2. With that history, does she have adequate glandular tissue?
3. With having bled X7 weeks (assuming no retained fragments) + 2 toddlers
to take care of also, is she getting enough nutrition/fluids/rest?
4. With all that going on, and the stress of worrying that history will
repeat itself, is she getting a good let-down?
5. It's never too late for Reglan - have used it 50-60 times over the last
couple of years in moms who were pumping for premie or ill babies in NICU -
some used it several months postpartum
with good results. Dose is 10mg four times a day for two weeks ( will take
4-7 days to see the difference), then wean it back down slowly. There are
some potential side effects, but the only one I've seen with any frequency
is dry mouth, and I explain to moms that it'll remind them to drink enough
fluids.
Good luck with this mom,
Becky Saenz, MD, new IBCLC and proud of it!
At 10:18 PM 10/11/99 -0400, you wrote:
>Hi gurus: I'm working with the mother of a 7 week old baby. This is
>her 3rd child - the first two were exclusively formula-fed by the end
>of the first week of each of their lives as a result of "not enough
>milk." This mother is extrememly committed w/this lactation experience,
>and despite pumping with a good pump every 2 1/2 hours bilaterally for
>15 minutes after having the baby at breast until self detachment, and
>then supplementing the baby with the pumped milk (yes...with a
>bottle...but she has 2 toddlers plus this baby and has to pump)..her
>baby is almost (and some days not even) gaining 1/2 ounce/day. He did
>not regain birthweight until 3 weeks. Now, following a case of mastitis
>one week ago, her supply has dropped to 50% of the baby's needs. She
>has a test weigh scale at home and is doing pre feed weight and post
>feeds: he takes anywhere from 1-1.5 ounces from the breast, and then
>she pumps an additional 1 ounce in 15 minutes. He is needing some
>formula to gain adequate weight. There is no history of breast surgery,
>injury, no known endocrine problems, no birth control pills, mom has
>been bleeding for 7 weeks and is going for a possible ultrasound this
>week to rule out retained placental fragment (she at least has an app't
>w/her ob to evaluate her bleeding); she's been on blessed thistle and
>fenugreek 2 caps of each 4x daily since week 2: she's exhausted (and I
>nearly am too) but wants to continue. If there is no retained placental
>fragment, and probably, there is not.......is 7 weeks out too late to
>try reglan? at what dose? for how long? and when would she see
>results? I just want to arm her w/this ammunition (and any suggestions
>for articles I could give her to take to her ob documenting efficacy and
>safety of Reglan, too) I would be forever grateful. thanks!!!! janna
>zempsky in w.htfd CT where it is almost "peak"
>
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