I have not had much success finding information on this, would really appreciate some direction/suggestions:  Incidence of low milk supply with hx of progesterone deficiency during pregnancy. 

With mom's permission to post for recommendations/suggestions: 

Mom had 2 miscarriages due to low progesterone and had successful term delivery with progesterone supplement to maintain pregnancy.  She had breast growth of one cup size during pregnancy, no hx of trauma to the breast and no hx of illness during puberty. She has normally developed rounded breasts, and everted nipples. 

Mom had an uncomplicated vaginal delivery with no excessive post partum bleeding. Nursing began immediately after delivery. Infant did not gain weight,  and at 1 week mom was seen by lactation consultant for no weight gain since discharge... skip to now, infant is 2 months old, still having to use formula supplement at the breast, (uses EBM and ABM) .

 At initial visit infant was not transferring milk and so supplement at the breast was started along with pumping after feedings for the supplement to be used at next feeding and mom began taking fenugreek.  With little increase in milk transfer (at this point infant transferred about 20- 25ml at feedings)  and no increase in volume expressed (she expressed between drops and 20ml)  mom was prescribed Reglan which after one day made mom extremely lethargic and she was prescribed Domperidone instead. She is now at the max dose of Domperidone and still no increase in supply. Other things mom does to increase supply are: compression compression compression, vibration stimulation, skin to skin, and allowing infant to comfort nurse at breast ad lib. The most infant transfers without supplement is 1 1/2 ounces after nursing from both breasts, (starts on one side, switches when not swallowing even with compression, then after nursing same on second breast goes back to first and then back to second.. at this point infant does not transfer milk when switched back a third time to the breast and will not stay on the breast if hungry and no milk transferring) When mom pumps after she gets only drops but she pumps to stimulate. She has trialed waiting to pump and she gets about 20ml. at the most.   Infant now feeds about every 2- 3 hours and has  1- four hour spacing at night. Mom is a powerhouse to continue doing everything, but over the last 2 weeks she understandably has grown weary of pumping after all feedings so she has started using the vibration stimulation instead after night feeding since she was not getting any volume at all or only drops during that time.   Infant is getting less than half of her milk from breastmilk between the EBM and transferred milk and the rest is ABM supplement. Supplement at the breast is done after infant is not swallowing anymore on second breast.
 
Other things:mom uses double electric pump, Medela, and stays in stimulation mode when no milk flowing, expression mode when milk flows and alternates. She pumps for 15 minutes if she is getting milk, if she stays in stimulation mode throughout pumping she pumps for 10minutes

Infant has no tongue tie or oral issues, no biting or chomping, no trauma to mom's nipple even in the beginning, feedings without supplement infant transfers what milk she does within 15-20 minutes. 

OK, I hope that was enough info, any suggestions for this mom would be appreciated, she is now happy that she is giving any breastmilk at all and that infant still loves to nurse from mommy even though mom has to use formula more and more at feedings. 

Thanks everyone for suggestions or literature that might help. 
Pam Price IBCLC  (recertified by exam this year! YAY!)
USA South Carolina 

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