Hi Lisa! I understand that you aren't trying to lump all allergies under
one cause. It's a complex issue, for sure.
On to a question I have. I was just on the phone today with a mother I
will see as an LLLL tomorrow (and may see as an LC down the road if she
decides to do that). She has a 2wk old baby, born at another hospital from
the one where I work; baby is still 6 oz under birthwt, insufficient
stooling/urination, unhappy baby (I don't have all the details
yet). Mother never felt engorged, has not leaked at all, can't pump more
than a drop or two (not hand-expressing or using a hospital-grade
pump). Says she does see milk in baby's mouth after nursing, baby does
spit up sometimes.
According to the mother, these are the things she has been told in response
to her concerns by her doctor, the baby's doctor, another LC, and an ER
physician: (day 1 when hourly attempts to breastfeed resulted in a total of
10 mins "latched on") don't worry, lots of babies don't nurse much their
first day; (at discharge) lots of moms don't get their milk in till maybe
even day 5, that's okay; (after about 12 days) the baby is gaining too
slowly but looks strong and reasonably well -- breastfeed 15 minutes at a
time and give formula if she's still hungry after that; (day 13, after baby
projectile vomited a formula with iron) keep it up for another day or so
and see if she gets used to it; (day 14, after mother tried another formula
and brought baby to hospital for breathing difficulty & facial rash) we
can't see anything wrong with the baby except she's not gaining very well
-- seems fine on formula.
I asked about her fertility and if she's had cysts on her ovaries (also
asked about thyroid problems -- none -- and medications e.g. Sudafed --
none): she has a history of menstruation only every 3-6 months till 2-3
years ago, is 26 and had begun to take steps towards fertility treatments
when she was happily surprised by this pregnancy. Once during an
ultrasound (I think) she was told she had cysts on her ovaries which the
doctor said would resolve or go away or something (I know zilch about the
physiology here) with her next period.
So, my question: Does this qualify as possible/probable PCOS with low milk
due to hormonal imbalance? And if so, do your current recommendations
involve metformin, goat's rue, and maybe domperidone? I don't even know
yet if galactogogues will be necessary, because I haven't gotten a chance
yet to evaluate the baby's latch or the mother's breastfeeding behaviors
(responsiveness to cues, frequency of feedings).
Elise
LLLL, IBCLC
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