As a professional labor assistant I worked with a woman who delivered 4
weeks early.  The delivery was an underwater birth without medicine.
Baby's weight at birth was 6.12lb and 2 days later (upon dismissal)was
6.06lb.  Two days after that during a breastfeeding weight baby was 5.08lbs
and had a bili of 17.8 (SURPRISE!!)  The breastfeeding weight showed NO,
gain (not even 1gm) in 15-20 minutes of nursing on both sides.  After
ordering bili lights and finger feeding formula, I had mom pump with a
Medela classic for almost 30 minutes (she had been using a pump in style at
home)......she didn't even get a drop.  As you all can imagine I spent
hours upon hours with this woman, teaching the SNS, how to count diapers,
when to call for help, etc.
I then asked her if she would have a prolactin level taken.  This was six
days following delivery still no milk (no placenta problems). Also her
mother and sister told me during delivery that they didn't get any milk...I
thought it was just another story.  Well, the prolactin was 86.7 and
according to the Lawrence Mosby Guide the base level should be 200 and rise
to 400 during the first ten days.
I know that reglan/domperidone, SNS, pumping, etc. could have all increased
her milk, but my questions are...with that level would she get any milk at
all?? What prolactin level will start the production of milk?  Will this
happen with future children, can a woman take domperidone during pregnancy,
did a miss anything?

Sandra B. Kelley
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