Hello all!
    I hope someone can assist me with this situation. I have a 26 yr old client 
who just birthed her first baby 5 1/2 days ago today. She has a nice 
aggressive baby and symetrical average sized breasts with NON flat nipples. 
She had a spontaneous labor that was sl. long in length and did include an 
epidural and pitocin after delivery. In the hospital she was doing great- good 
latch, suck, no audible swallowing but baby did maintain her wt and was 
stooling and voiding appropriately. She called me the day after her discharge 
with concerns that the baby was "starving". She was crying almost nonstop 
and had only had 1 void since 4am that morning (no stool since then also). 
Upon my assessment in her home, the baby had another void for me but was 
rooting like crazy. Mom's breasts did not feel full in the least (this would have 
been day 3 1/2 after delivery). Mom denied feeling a lot of changes with her 
breasts during the pregnancy. She had a NEGATIVE hx for thyroid, diabetes, 
surgery, PCOS, infertility or any hormonal issues. She denied any medication 
use. Her own mom successfully nursed 3 babies for over 6 mos and was with 
this client almost continuously giving her support along with her husband. The 
only thing that rang a bell in my head was that this poor girl was visibly 
shaking (from frazzled nerves she explained). She also had not slept nor ate 
much. 
    I immediately turned the tv off, put on music, dimmed the lights, calmed 
the baby, etc.etc. and then helped her put baby to breast. I witnessed a 
similar sight as I had in the hospital- aggressive baby (once calmed down a 
bit) with a deep latch and nice suck (on a finger, pacifier or breast). Maybe 1 
or 2 soft swallows within the 10 min feed. We even relatched a couple of 
times to double check placement. Her suck never really changed to look like a 
let down suck/swallow. After the feed I could get a drop or two with manual 
expression but that was it. (I had already had mom take a warm shower and 
massage before my arrival). The same scenario played out with the opposite 
breast except the infant got very upset only 8 minutes into the feed. Her 
mouth appeared somewhat dry after the feed and her cry sounded sl. hoarse. 
(Pumping with a double electric pump for 10 minutes only gave us a couple 
drops as well.) Obviously there was no change with the breasts after our 
attempted feed and pump. 
     I do not like to supplement with formula but since we had no colostrum or 
milk... we did not have a lot of choices. We dribbled soy formula down mom's 
breast and the baby readily sucked it up. We followed that with a syringe feed 
of more formula to get something in her tummy. Baby tolerated everything well 
and seemed much more content. Mom agreed to cont. the freq. feeding 
attempts. supplementation, pumping, etc. after I left. Her mom was going to 
stay and she and my client's husband were going to make she that she ate 
and slept.
     I talked to her numerous times once I got home and she revealed that she 
was noticing a sl. increase with her production with the last pumping session. 
I was thinking this was good. She seemed to be more relaxed. This mom told 
me that she had been excited about breastfeeding since before she became 
pregnant. (Yea- determination!) All along she has been such a sport until 
tonight. After everything she has been doing she now stated that she is not 
sure if she can do it anymore. She was very tearful (which I am hoping is a 
hormonal change/milk finally coming in sign) and upset. I tried to offer her 
support and encouragement and come up with a plan that would most help 
her. I feel so bad for her and wish that I could make it better. The thing is 
is that I am stumped as far what is going on! I questioned her again about her 
hx and she suddenly revealed that she is on and has been on reglan 
for "stomach issues". She has been taking it throughout her third trimester and 
stopped after delivery. She just yesterday took it again (10 mg twice a day) 
for the first time since delivery. This was also the first day she saw an 
increase in her production (only 5cc's but better than nothing).
        My question to all of you knowledgable experienced lactnetters is this....
Do you think being on the reglan could be playing a role in this? Am I just 
reaching for straws here? I have some experience with reglan greatly 
increasing a woman's supply but then greatly diminishing it when stopped so I 
don't routinely encourage it. Should I contact her Dr and now see about 
increasing the dose? Have we not waited long enough? Tommorrow will be day 
6 and we are still at 5cc's with pumping. (She is obviously still supplementing). 
What are your thoughts? Am I missing something? Have any of you 
experienced a client on reglan before delivery with milk issues afterwards? I 
considered maybe asking her Dr to do some prolactin levels too. I am also 
aware of the difficulty that "nervous nellies" have with nursing too. I know 
that adrenaline can interfere with let down but what about supply? Please tell 
me what you think as I don't want to be missing anything and let this girl 
down. She really is at the end of her rope as am I. Thanks in advance with 
any thoughts you may provide. 
                           Frustrated in Ohio

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