I have had a bunch of moms with low milk supply with no obvious
underlying causes.  What's going on?  And of course these moms are the
ones who want to breastfeed in the worst possible way!

I have a specific case I would like some input on.  Mom is mid-30's, son
#2, born by repeat c-sec because of meconium in amniotic fluid 4/4/01.
Due date was 4/11/01.  Son # 1 is 3 years old and mom tried to breastfeed
him, but was never able to get him to latch well (she didn't seek help
either).  She pumped first with a hospital grade pump then a Pump in
Style (when she returned to work) for about 5 1/2 months, bottle feeding
breastmilk plus formula supplementation.  She was never able to produce
more than about 2 1/2 oz per pumping session.  This time she was/is
determined to succeed and has worked with LC's from week one.

I got into the picture 4/16.  Baby goes to breast most of the time and
latches without pain for mom (corrected after bleeding nipples in first
week).  Latch looks good, some swallowing is heard, but doesn't want to
stay awake for long.  Using a BabyWeigh scale, he is getting approx. 0.3
oz from one breast, approx 0.1 from other breast. Mom has been on
fenugreek, 2 capsules/3 times per day since Monday evening.  Pumping
after feeds with PNS now is producing 1 1/2-2 1/2 oz after much lower
yields earlier.  But even with mom's increased supply baby's intake
hasn't increased. Why?  He has no obvious ridging on the skull, suck
feels vigorous and good on my finger.  Mom is willing to practically walk
on nails to make this work.  I gave her Dr. Jack's handout on domperidone
today and she was gangbusters to get it ordered this afternoon.  I have
referred her to a pediatric OT that I know is good for suck evaluation
and possible sacral cranial.  Parents are renting the BabyWeigh scale for
a week and dad is checking intake regularly (an engineer type) to help
them know how much supplement to give of breastmilk and formula if more
milk is needed than available.  Baby is just now up to birth weight, but
looks good, skin tone nice, color good, alert when awake.  What am I
missing?

Please reply privately as well as to the list.  We are leaving for the
weekend for an out of state wedding and I know I will return to lots of
digests that I won't be able to get through quickly.

Thanks,
Pat Bucknell, IBCLC
Avon Lake Ohio
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