Barbie,
Thanks for the domperidone offer.  I will relay it to the mom.

In reference to your question about breast augmentation.  I attended a
session at ILCA on breast augmentation and reduction & BF'ing.  The LC's
were in an area where the procedure is done a lot.  They essentially said
that any type of breast surgery is a red flag.  There are no "givens",
you just have to watch to see how the baby does.  When nipple removal is
done, then all the nerves are cut and there is no feedback bodywise to
the baby suckling.  So those moms really have been hit with a double
whammy--breast surgery (and there are several methods of doing the
augmentation, some that disturb the inner workings of the breast very
little, and others that do major damage) and removal and re-placement of
the nipple with all the scar tissue and numbness that that entails.  So
if the baby is not gaining well, it could certainly be mom having a
diminished supply as a result of her surgery.  She may be able to build
up her supply (you didn't indicate how old baby was), but she probably
also needs to supplement as per Linda Smith's 1st rule:  Feed the baby!
Supplementation then brings up the discussion of how to do it--tube at
breast, bottle, finger feeding, SNS.  Don't know what you have easily
available in S. Africa.

Good luck,
Pat Bucknell, IBCLC
Avon Lake OH
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