Hi Willow,
One thought...you mention blood loss...is it possible that a piece of the
placenta is retained?  Good Luck, and keep us informed.
Lucy,WI

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> From: Willow A. Ward <[log in to unmask]>
> To:
> Subject: HELP: failure of Lactogenesis
> Date: Sunday, November 23, 1997 7:30 PM
>
> 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]
>