I have a client who had minimal breast changes during puberty, some changes during pregnancy and felt her milk come in on day 3 of this, her first baby.  I saw her at day of life 8 - baby still 9% below birth weight.  Did a test weigh - baby transferred 0.3mL!  Pumped with pump in style after - NO MILK!  Started on Reglan next day with "some Improvement" pumping about a 1/2 an ounce - then I left my test weigh scale with her for 3 days and suggested she do a test weigh about once daily to see if her milk was increasing.  She did not do this - she merely weighed the baby naked once and the baby had gained milk (but was being supplemented w/12oz of formula at the time)  She has a history of hypothyroid and is on Synthroid - I suggested she contact her ob for a thyroid screen to she if her hypothyroid was in good control, and also ask him to add prolactin level.  Her thyroid in fine. Unfortunately, I left it up to the ob or the lab to tell her when to pump in relation to this - NO ONE DID.  Her level is 131 on Day 5 of Reglan, this is 3 hours after her last feeding/pumping session.  Is there anyway to interpret this?  I was mostly doing it to get info. about whether she may have insufficient glandular tissue.  I have read that if she had a very high prolactin level w/minimal milk, that that was likely.  As you can tell by the lack of use of the scale, she does wish to have things be as calm and un-technical, un-clinical as possible.  I may just go on with weaning her from the supplement as long as the baby gains weight, without test weighs or more labs.  Any advice?  I'm sure she would not go back to the lab for a triple prolactin or a prolactin after pumping.  I think test weighs really make her anxious as well.HELP!  Janna in cold wet Connecticut

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