I am currently helping a 25 year old primigravida with a normal pregnancy
and c section delivery who is 4 weeks post partum and has no milk. She had
no difficulty getting pregnant, had increase in breast size with pregnancy
and normal appearing breasts. The mother was not given the baby for 6
hours. Then told she had inverted nipples (they are inverted but can be
made to protrude) and given breast shields. She nurse with these for about
1 week and the infant continued to lose weight. Was told to supplement with
bottles and the infant gained weight well. Mother continued to pump with a
not very good pump (converted suction pump which is the most easily
available one in Israel). I first saw her at two week of age when she
claimed she had no milk. I suggested finger feeding and a better pump. The
finger feeding went very well and pacifier discontinued as well. Suggested
skin to skin contact and to keep trying to put infant to breast. Started on
metoclopramide (Reglan, Pramin). One time got 20 cc of milk and then supply
dwindled. After one week given Domperidone. Continues to pump but says less
than 5 cc come out. I suggested an ultrasound and gyn check to rule out
retained placenta and she will continue to pump until we have the answer
(currently the MDs are on strike in the clinics). Does anyone have any
other ideas.

Mother is generally healthy, on no medication, not exeptionally exhausted
and seems to have no obvious explanation of the failure to relactate.

Thank you

Deena R Zimmerman

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