I'm following with interest the discussion about the P3 woman with poor
milk supply who has had her prolactin levels checked.  Reason being last
night (1 hour before I was due to go home!!) I was presented with a first
time mother who has been readmitted with her baby now 7 days old.  At 5
days the baby was found to be dehydrated, very sleepy and still losing
weight - readmitted.  Since then the baby has been NGT fed formula - mother
has been expressing minimal amounts. Baby too sleepy to suck at the breast
initially, so SNS was not an option.
Last evening he finally decided he would latch onto the breast - that was
when I was called in.  He latched and sucked beautifully for a brief time -
added the SNS and he sucked a little longer, but basically still needed
most of the feed down the tube. At this point I felt he was still
recovering from minimal food for 5 days and mother doesn't have enough to
keep him interested for long.
She reports no family or personal history of hypothyroidism (she had
gestational diabetes). It took her 12 months to get pregnant. She is
overweight.  (Just mentioned those as they may indicate hypothyroidism, but
may mean nothing as well!)  Delivery was a failed vacuum ending in a
c/section.  (Good and bad here - not so good for baby's sucking ability and
responses, but surely there can be no placenta retained after a c/section).
 Her lochia is still red, but decreasing to small, fundus 1cm below umbi -
mmmmm.  She reports maybe some breast changes in pregnancy, has never had a
full heavy feeling in breasts postdelivery and certainly never engorged.
She was started on metoclopramide 2 days ago.
Today baby is to have u/s scan of head and blood tests - one to exclude
hypothyroidism (don't know why - I suggested it for mum not baby... is
there a reason here?)
Mother is having full blood picture done, thyroid screen and cortisol levels.
Now my major question - should we check prolactin levels? If so, and
they're low, what would we do about it?  Metoclopramide is pretty standard
here for anyone who remotely looks like they might have a low supply
anyway.  And, as Heather queried - what's normal for when? even have to
note time of feeding in relation to blood taking.  And again, what would we
do if it was low?

Ahh the mysteries of lactation - it's what keeps us interested.

Looking forward to many replies.  (again I concur with Heather - Cindy you
were out of my personal experience level)

Denise

****************************************************
Denise Fisher, BN, RM, IBCLC
BreastEd Online Lactation Studies Course
http://www.breasted.com.au
mailto:[log in to unmask]
****************************************************

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