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Subject:
From:
Christine Choong <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Thu, 29 Apr 2004 21:25:35 +0800
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Hi,
I have previously posted about this mother who has battled many difficulties but I would appreciate a little advice. She breastfed the 1st 4 days after birth but stopped feeding at the breast due to difficulties with attachment due to engorgement. Unfortunately she was not advised how to deal with this. She was then advised to express & syringe feed which she did for about 2 weeks but was concerned as her supply was very low particularly on the right breast. I first saw her at this stage. We did manage to get the baby on the breast but despite the attachment looking OK baby sucked rapidly with  very few swallows. Two days later she was told by a visiting midwife that "she had thrush on her breast but as the baby did not have it in her mouth she should stop breastfeeding" !!!! Following this she also developed mastitis & had infection in the nipple.
She continued pumping but not breastfeeding. A doctor prescribed medication to be used on the baby if baby showed signs of thrush. Mom treated her  breasts with  daktarin. She continued pumping but as she was obtaining insufficient milk for her baby's needs she supplemented with formula. I saw her again & found the baby very unsettled & arching if she was near to the breast. We did finally get the baby attached using a modified football hold with the baby's legs pressed against the back of the seat & both mom & baby seemed comfortable with this position. She was then prescribed Domperidone 20 mg tds by a paediatrician which she has now been taking for 4 weeks. I saw this mother again at a support group this morning. She is still obtaining 1-2 ozs from left breast & half to 1 oz from right breast when she pumps. A few days ago she apparently tried all feeds at the breast for approx 12 hours ( with baby at the breast for most of the 12 hours) but reintroduced supplements with either EBM or ABM when baby did not PU for several hours. This morning in a situation where mom was more relaxed, we again tried baby in the modified football hold & she again remained at the breast with rapid sucks & occasional swallows - however much improved on the last time I saw her.
Mom mentioned in passing that she was diagnosed with PCOS shortly before becoming pregnant - investigated because periods were more frequent & longer after discontinuing contraceptive pill.( She previously hadn't thought it relevant & had not mentioned it when discussing her medical history) Diagnosis was made on basis of a scan & physical appearance. My question - is this likely to be affecting her milk production. I know PCOS can but this mother conceived without assistance, had breast changes during pregnancy & engorgement on day 4- 5. She is very keen to fully breastfeed but is very exhausted with frequent feeding & pumping. I want to encourage her but do not want to be unrealistic if there is a liklihood that the low supply is due to PCOS.
My second question. She is planning to continue with Domperidone as she is seeing a slight improvement. However in Jack Newman's info. sheet there is mention of tumour formation in rats. I appreciate that this is with abnormally high dosage but this lady has a high incidence of breast cancer in her family & just wants to be extra sure!! I would be extremely grateful for input.
Thanks
Christine Choong 
SRN. SCM. IBCLC Childbirth Educator
PS. I have looked at the archives.

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