Jaye,

I'd probably want to know about the mother's progesterone levels, if they're marginal for sustaining the pregnancy I'd consider supplementing in the last few weeks before the birth to help induce that precipitious drop in progesterone that helps initiate lactogenesis II.  Some exploration into what her fertility issues were, exactly (why she needed clomid) might shed some light on the underlying hormonal issues.  If she's got PCOS or diabetes, I'd want to make sure she's using glucophage or metformin, if that's what her doctor thinks is appropriate when she's not pregnant.  I'd also be educating the mother like crazy about what proper breastfeeding management is, and encouraging her to take control of her birth experience as much as she might be able to in order to stack the deck in her favor.  Since she's already comfortable with an SNS supplementer, getting her to use that while working on bringing her supply in won't be a struggle.

Locating a donor would also be high on my priority list at this time.

Mothers tend to do better with subsequent babies so maybe this time around, her body will have a better idea of what to do on its own, which would be fabulous!

--Diana in NY, always with a concerned eye toward these committed moms with low milk production...

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