Dear Wise Women, 
I have been on Lactnet for a few years now but I rarely post. I am in private practice in the Phila area,(after working many years primarily in the hospital as a nurse in L&D &MIU )I  am having a small run of mom's with low milk supply that isn't (mostly)from lack of milk removal. 

I want to know after frequent nursing/ pumping..how can I help a mom with low milk supply? 

Mom A: 1st baby, gestational diabetes, infertility,(but no PCOS) some breast growth during the first trimester but said her breasts were back to normal size when I saw her at 6 days. Her breasts were soft, but didn't appear abnormal. 
She was already supplementing after a >10% weight loss in the hospital due to a poor/no latch. 
Our initial plan was feed the baby and remove milk to build supply. 
 
We got the baby latching with a shield at the second visit but he gets easily frustrated ,so she only does it when he's not fussing, sometimes after feeding with the bottle. 

 Her doctor said her Thyroid levels were normal during pregnancy but at my urging she did get tested again this past week and told me it was normal. (She didn't know if she got a panel but will look). I will ask about her bleeding. I thought about Domperidone but I think that with the heart rhythm controversy it's not prescribed around here anymore. I searched the archives about it but didn't see anything new, but I did see a mention of goat's rue. Mom is already taking Fenugeek on her own. At ~3wks she says she latches about 4x and pumps 8x (with hand expression before and after) and gets 6oz/day, up from 5oz 1 week ago.I recommended hands on pumping. Yesterday she told me she started power pumping. I will be seeing her again tomorrow. Thoughts?

Thank you in advance,
Carol
p.s.If anyone knows of a Breastfeeding Med doc (other than Penny Soppas who is not taking patients outside of her pediatric practice), please let me know.

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