To a few thousand of my best colleagues,

I've combed the archives to see what I could be missing and found nothing.
Help!!!

Mom is 33yo, gave birth at 28 wks, been pumping ever since - q 3 hrs X 15
min. during the day (6-7 times / 24 hrs.). Using double, hospital-grade,
automatic rental pump. (The green one.)  Have checked fit of flange to
mom's nipples, and it seems good.  Milk supply was fair first 2-3 weeks,
then tapered off.  Wasn't feeling let-down.  Tried oxytocin nasal spray
without much success.  Didn't want to do "herbs", but tried Reglan without
much success either.  (We don't have sulpiride or domeperidone in US.)  On
no other meds except prenatal vitamins and iron supplement.

Non-smoker, no hormonal birth control, TSH normal. Adequate glandular
tissue by exam, and reports "some" breast enlargement with pregnancy.  Hct
= 37 so on iron supplements. Prolactin level = 8, so probably not
Sheehan's. No history of hemorrhage or abnormal bleeding during pregnancy
or postpartum.  Dietary and fluid intake seem ok.  Getting naps and rest.
Only thing I haven't done is a pelvic ultrasound looking for retained
placental fragments, but she had an ok supply first 2-3 weeks, so unlikely.

What am I missing?  What else can I do to help this mom, who desparately
wants to provide milk for her baby?  TIA,

Becky Saenz, MD, IBCLC

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html