Mary,
I have recently worked with a mother with this syndrome, who also had no
milk.  In her case, she needed progesterone shots to start her periods and
clomid to get pregnant.  Her first pregnancy was ectopic and she was given
methotrexate after this pregnancy (I'm curious as to the reason if anyone
wants to enlighten me).  This was her second pregnancy and she had
gestational diabetes requiring insulin, perhaps because of obesity.  When
we were pursuing possible reasons for the lack of milk I questioned her OB
about the polycystic ovaries and he was sure there was no connection.  He
said this is a fairly common condition.  (Is this true?)

This mom was intent on bringing her milk in so did everything I
knew--nursed frequently (baby was cooperative and nursed enthusiastically
to get out the few cc's she produced), pumped after with hospital-grade
double pump, tried a course of metoclopramide (Reglan), plus took friend's
suggestions of fenugreek and brewer's yeast.  For the first couple weeks
everytime we talked over the phone she was sure her breasts were fuller, or
she had some leaking, or she heard more swallows--it was very sad.  We did
several feeding assessments and baby never got more than 4cc's total.

With the history of the mother you're dealing with I would be very
surprised if anything is different this time.  I wonder if the underlying
cause is related to the need for clomid--it seems that a greater proportion
of the moms I see with low or no milk (and non-hypoplastic, non-incised
breasts) have had infertility issues and taken clomid.  And as far as I can
tell, having colostrum has nothing to do with later milk production.  I
used to be falsely reassured when I would see and hear indications of baby
swallowing colostrum when mom had suspicious-looking breasts.  The presence
of colostrum no longer reassures me.

I am continually frustrated by the number of mothers I see who have low/no
milk supply that is not related to breastfeeding mismanagement.  I wish I
had some answers for these women.

Becky Krumwiede, RN, IBCLC
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