Janna,
If mom's blood test was taken in the first 10-90 days, she falls well within
the range for a normal lactating woman at baseline (60-110), according to
Lawrence. Baseline for first 10 days is 200. I don't know what mom's numbers
(131) say about her pre-reglan levels; I only know that reglan is supposed
to double whatever milk production you had (general rule).

Thyroid question: I came across an intriguing piece of information in the
course of some research. The article was examining milk supply in diabetic
women. Here's the quote: "These data suggest…..  that hypothyroidism may
influence the initiation of lactation even when patients are euthyroid
(apparently normal level) due to treatment."  (citation below) We have
assumed that if a woman has been treated, then thyroid becomes a non-issue--
not necessarily true.

I think that an important question to ask is how long has she had thyroid
dysfunction; if since puberty, that could have affected breast growth then
and account at least in part for the "minimal changes." Same for pregnancy.
What do her breasts look like? Anything else about her health or
reproductive history?

This mom needs to be followed very carefully if she is trying to go to
breast only. Personally, I prefer at least periodic test weights to document
increase in milk transfer, but if mom is really uncomfortable with this, you
can try monitoring either by counting swallows, or by timing the active
eating,and see if either of these continues to increase and *need*
(unforced) for supplement decreases. Baby's weight gain should be monitored
during the process to know that baby is getting enough one way or the other.

Whether or not this mom has insufficient glandular tissue, keep in mind the
findings of Huggins et al that it could take several weeks, up to 3 mos, to
see mom's maximum potential for milk production in the case of questionable
breast tissue. This implies a need for persistence, patience, and adequate
supplementation for any deficit.

Lisa Marasco, IBCLC

    Miyake A; Tahara M; Koike K; Tanizawa O.  Decrease in neonatal suckled
milk volume in diabetic women.  Eur J Obstet Gynec Reprod Biol 1989;
33(1):49-53.

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