I had an interesting case today that I would appreciate the collective wisdom
of all you wiseones.  I am presently no-mail, so please e-mail me with
response as well as Lactnet.

Mom in late 30's, mother of five children ages 18, 16, 14, and a nine day old.
Fourth child was killed in an accident when only 28 months old.  The fourth
child was breastfed at time of death and the mother continued to produce milk
for over a year when she saw a doctor who did an MRI and found problem with
pituitary, blood work revealed elevated prolactin levels.  The doctor
prescribed parlodel which she took for about a month and lactation ceased.

Present baby, nine days old, was born at home delivered by midwife.  Birth
weight was 8# 8oz, was seen in our office within 24 hours for new baby check.
Weight was 8# 5oz.  Mom called and scheduled appt. with me on Tuesday due to
concerns that baby wasn't getting enough.  Called and rescheduled for
Wednesday, then, canceled Wednesday.  I called her and she indicated that baby
was stooling more and she felt things were improving, I suggested that she
might want to just bring the baby by for a weight check.  Today (Friday), she
brought baby in with "brick dust" urine to see a doc.  Baby was down to 7# 5
seemed very dry and yellow.  Bili was only 9.6.  Mother told doc that she
feels her milk just came in yesterday.  Doc referred mom over to me for
assessment of breastfeeding.  I watched baby at breast, good latch, I did
improve positioning some.  No sign of swallow, no weight gain.  I tried a tube
on syringe and gave a little glucose water at breast to illustrate to mom what
a nutritive suck-swallows looks like and she said she had not seen these.

Mom had completed my two page history and I began asking questions.  I
discovered mom has been on synthroid for several years for low thyroid, but
she had stopped taking it for the past 2-3 months.  She never knew
discontinuing it could effect supply. She did realize that her supply was slow
to come in and has been having her 18 year old who is nursing an 8 month old
to nurse the baby twice a day.

I had mom pump with Classic for 15 each side only saw one drop from each
breast. Present care path is to have mom resume taking synthroid, start taking
fenugreek and blessed thistle.  To feed baby at breast using SNS, 8-10 times
per day.  Lots of skin to skin contact and offer breast anytime baby wants to
suck.  Did not recommend any pumping at  this time as baby had a nice suck
pattern at breast with SNS.  First priority was to feed the baby and get some
weight on the little guy.
They will be in on Monday to see me again, I will keep you all posted with
outcome.

Any suggestions would be appreciated along with any educated guess as to how
long it may take to establish a supply.  Thanks lots, you all are the best.

Warmly,
Pat Lindsey, IBCLC
Pediatrics Plus staff LC and Private Practice