A question for you wise women... I don't post often, but do lurk very often! 

I have a patient 3 months PP who is struggling with milk supply.  It is her first baby. She is currently taking domperidone. We did a prolactin level and surge, although, I believe the surge level was not at the full 45 minutes. Her prolactin level is more than adequate at above 200ng/ml. The rise for the surge was minimal, about 20 ng/nl. She also had a post partum hemorrage with a hgb at 8.5. Normal PP course otherwise and appropriate involution of the uterus.  She also has a wide space between her breasts and average size breasts that are more long than rounded. 

Is it worth doing another prolactin and surge level with the appropriate time interval? Since she is already taking Domperidone, I am not sure of the next step. I did offer U/S to evaluate for retained products, although, I doubt this is an issue. 

Jerri Walker, CNM, MSN, IBCLC
Back Cove Midwives
Portland, ME
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