I am endlessly amazed and impressed at the wealth of info we share in
this incredible forum.  I've been lurking for a while again, so I'll
reintroduce myself.  I am an RN with 20 years NICU experience who just
became an IBCLC this past year.  Lactnet and all you wonderful people
were a huge help in enhancing my knowledge of the "normal, un
hospitalized" breastfeeding world.  Thank-you all!!  And to all you other
NICU people out there it's nice to know my battles are not solo nor
unique.  It is an uphill struggle some days but progress is being made
when a neonatologist is able to do the basic problem solving on his/her
own.

On with my request.  Our department here in Denver CO, has been working
with a similar Mom to Brenda's.  This mom had her milk come in at the
29th week of her pregnancy, she had 3 days of unrelieved engorgement.
This was her second pregnancy, she had gone into premature labor  at 28
weeks.  She was placed on meds to stop labor and a week later she became
engorged.  She cont with occas. leaking until delivery at 34 weeks gest.
, September 18.  Her baby was born with an abdominal wall defect
requiring immediate transfer to a high risk center here in Denver (the
family lives in Wyoming),  and then later transferred to our unit at The
Children's Hosp..  This mom began pumping by day two of life, every 2-3
hours, as her infant was medically unable to be fed due to numerous
complications.  This mom suffers from PPD is on a low dose of Zoloft, but
still VERY fragile.  She is extremely anxious to be able to breastfeed
her infant as he cont. to recover.  Her milk supply has been dismal from
the beginning and she never experienced engorgement after the infant was
born.  She was on Reglan for three weeks which resulted in an emotional
breakdown and no increase in her milk volumes.  The baby has begun low
volume cont. feeds.  He began breastfeeding "practice" sessions this week
and has done amazingly well for his age and condition and history.  Mom
had her first letdown yesterday and was thrilled.  Due to family concerns
she is only able to visit 2-3 days out of the week.  We will maximize
holding and breastfeeding as  much as possible during these visits.

Questions:
1  What caused her milk to come in with an intact and functioning
placenta?
2  Any other ideas to boost her supply?
3  How often does this scenario occur?  We looked in the obvious places
and found no cases.

Any feedback greatly appreciated.  This is one really great and
incredible stressed family.  The entire history would probably melt down
the server.  Thanks in advance for all your great thoughts and help.
Sorry for the length of this!

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