Jennifer,
Although we don't have complete information in regards to how soon, how much
this mother was supplementing, this sure sounds like a case of insufficient
glandular tissue. When the mom says the baby was gaining wt this could have
been a very slow gain after an initial big loss, and probably w/ supplement.
When the mother says the baby was wetting, again this could have been
minimal amounts and what were the stool patterns?
These things indicate to me that her milk never came in:
"Although the baby was gaining weight and output seemed OK he didn't seem
satisfied much of the time. I never heard or saw him swallow much or felt my
milk let down. Also, when I would pump, I would get next to nothing out of
either breast. I continued to breastfeed however because everyone said it
was normal for new nursing moms to think they didn't have enough milk. It
wasn't until my son was about 5-6 weeks old that I started to know that
something was wrong. I
would put him to the breast and he would latch on great. He would vigorously
try to nurse for a few minutes and then come off the breast.When I would try
to express milk by hand to get him started, I would get nothing and my
breasts would definitely feel empty."
Possibly she has some syndrome like PCOS? Does she fit that picture at all?
If her prolactin levels were high that may be why domperidone did not work,
it raises prolactin levels. But if her levels were high or normal but she
didn't have the glandular tissue for it to work on, then it wouldn't make a
difference.
Sorry, I don't have an easy answer or treatment for this mother, other than
possibly some herbal remedy for breast tissue growth (goat's rue?) that may
or may not make a difference. Perhaps she can consult an herbalist to
develop a recipe for her. I would have her do all the optimal bf practices
like early, ad lib feedings, skin to skin, domperidone again if it didn't
give her side effects (could help) as some studies show multips do better w/
each lactation. So I would encourage her, provide close followup, and
supplement the baby as needed (her method of choice).
Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA
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