Could anyone add insight to this situation? (permission to share)
I saw the mom prenatally and at 3 days PP. This is her 4th baby and breastfeeding went well with only the 2nd one. The first had some placental problems which I guess could have caused her supply problems. The third was a month early and had problems gaining from the first. I saw him at the prenatal visit- he is 2- and he did have kind of a high narrow palate but tongue function seemed pretty good. He is in speech therapy, though. 
Mom has no sign of hypoplasia, no chronic health problems. This baby appears to have good tongue function but just doesn't seem to milk the breast well. We did talk about CST but I don't think she ever went. When I saw them 3 days PP, the conclusion we came to was small baby, large nipples, will be OK when she grows a little. She began pumping, taking fenugreek and blessed thistle, and soon after that started on Dom. Thyroid levels were done. 
Now we're 2 months out and she still has to pump 8 times per day to keep her supply from slipping. Needs to hold baby on the breast or she slips off, does all kinds of compressions/ massage at breast to help her get milk. Baby is gaining fine at breast only. But if mom cuts down on the pumping, she feels her supply decreasing. All her pumped milk is going into the freezer. 
As I write this, I think I probably need to check baby's tongue function again, and possibly see if we can find someone else to help her. She has seen an IBCLC with lots of experience who didn't have much to add. But I'm puzzled about why she needs to pump to maintain supply when baby is gaining/growing well. Also, she states the Dom didn't help her supply very much, which makes me wonder about what is causing this problem if raising prolactin isn't having that much effect. Is this only a baby problem or is there something else we could be looking for in the mom? 
Mary Taylor, LLLL

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome