I'm hoping that a few of the wise women here will have some ideas for
working with a mom who contacted me Thursday evening as I was headed out of
town.  Here's the story *as I heard it*.  (One of those unpleasant
situations in which I am the 4th LC to be contacted.)

Mom bore twins at about 34-36 wks gestation, 3 weeks ago after a month in
the hospital, on first Brethine and then mag sulfate.  Twins were initially
in NICU; mom was stared with a Classic double pump in first 24 hrs.  Has
pumped regularly since then, although has changed from every 2 to every 4
hours and back again on advice of various people.   She has NEVER OBTAINED
MORE THAN 20cc per breast per pumping session.

Babies are home now, and one or the other does take the breast, for about
10 minutes, at each feeding.  Although the babies seem quite willing to
"nurse" in this way, no one has evaluated for evidence of milk transfer, or
done any test weights, to this point; the babies are being bottle fed abm,
even after their time at breast.

Mom was given a 10 day course of Reglan at the recommendation of on of the
hospital LCs, but as of the 10th day (Thursday) it had resulted in NO
change at all.

Mom reports that she had no net change in bra size during pregnancy -- she
feels that she had increased in size but "regressed" while in the hospital
antenatally.  She did have changes in the nipple/areola as typical.  She
denies any illness either prior to, during or since pregnancy, except for
the bout with preterm labor.

Mom is anxious to breastfeed, and has contacted me because (as she tells
it) the hospital LCs have gently suggested that she give it up.  They have
offered several possible reasons for her inability to produce an expected
volume of milk: the "stress" of having twins, or of having been
hospitalized for so long; the effect of mag sulfate, and the unknown...

I have not yet seen the mom, done a thorough history, examined her breasts,
or observed a pumping or feeding session.  Others have, for whatever that's
worth.  I will probably have my chance either tomorrow or Tuesday.  I know
that I need to investigate issues of blood loss during delivery, and
thyroid status.  I know that an SNS or other similar device may be helpful
in establishing at-the-breast feedings, making mom and babies more
comfortable and minimizing the amount of time spent on the
nursing-and-bottlefeeding-and-pumping routine.

But what else?  I have been lucky enough never to have encountered such a
nearly complete failure to produce milk despite what certainly appears to
have been almost-appropriate management.  Can someone please offer me some
guidance?  What happened here?  What might still help?  Has anyone ever
seen milk "come in" in normal quantity this late in the game?

Please respond by private e-mail (as well as to the list if appropriate),
as I am about 2 weeks behind on journals... :-(   Many thanks in advance.

Willow        [log in to unmask]