Many thanks to my fellow LactNet-ters for all your help.  I seem to be
attracting interesting cases lately! Posting with mom's permission of
course--"Hannah" is 4 months old.  Mom was diagnosed a few years ago with
PCOS, treated with metformin.  After delivery, she pumped after feeds with
a hospital grade pump and her milk came in day 7.  Her OB increased her
metformin from 1000mg to 1500mg (would not increase it further over concern
for her blood glucose) and she did 2 courses of Reglan. Baby was nursing
well and gaining weight until grandma had a sudden illness and mom had to
care for her.  Supply dipped from the stress and lack of time to pump.  Mom
has maintained some milk supply, continuing to pump and adding fenugreek
supplement. She continues to "feel fullness" in her breasts and leaks a
good amount of milk  but has been unable to pump despite trying different
pump flanges positions and pumps -- only 'drops'.  In addition to her
supply being tenuous, it seems that let down is an issue-- even hand
expression does not yield more than drops.  We've worked on relaxation and
"let down" exercises.  Baby is now down to nursing once daily, she becomes
fussy at the breast otherwise.  We have tried an SNS but mom feels this is
too cumbersome, she gets anxious and I feel this tension seems to further
hamper her let down.  Mom desires to continue nursing and we've had the
"every drop counts" discussion.  She's okay to just nurse once a day but
I'm wondering if there's anything else I am missing here?

Molly Scarborough McMillion RN, BSN, IBCLC, CCE, CPST
Lactation Consultant, Childbirth Educator
Special Projects Consultant - West Virginia Perinatal Partnership
Right from the Start - Direct Care Coordinator
304.667.4362   www.babylovegbv.com

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