I have a mom who has a 5-day old...

I tried to help her with her first baby...seen at 4 days of age.  She has
small, but normally shaped breasts.  She became increasingly engorged until
day 5 with first, despite pumping. (tried all sizes of flanges)  Baby
transferred up to 4 cc at a time, and only ably to pump up to 10cc.  Mom
very frustrated...tried oxytocin nasal spray...no help.  At 8 days, baby
transferred none, and pumping 10cc. Started DOmperidone and fenugreek.  At
12 days, mom pumping 10-30cc at a time.  At 3 weeks baby became very fussy,
and ended up with cowmilk allergy...on neocate by 4 weeks...mom unwilling to
avoid dairy to provide small amounts of breastmilk and weaned.  In
retrospect, I blamed lack of milk on several possible factors:  mom took
sudafed from before birth to day 4, had lots of pitocin and was really
edematous, sleepy baby, on synthroid (with normal levels) and did not
respond well to pump?

This time...no swelling, no sudafed, baby vigorous.  Seen at 3
days...transferred 4cc from each breast.   Pumped drops.  Breats felt full.
Day 4, mom reported no increase in swallows or pumped milk.  I have not yet
heard from her today...but my fear is she still is not producing any more
milk.   Does anyone else see this???  I am much more comfortable with moms
who have obviously hypoplastic breasts...or no changes during pregnancy.  I
have even seen a mom or two who become engorged, but do not appear to
respond to the oxytocin, and had failed inductions requiring c-sec...looking
like they have oxytocin receptor problems.  (this mom delivered vaginally
and has cramps with feedings) But when they have normal appearing breasts
that become "full", with palpable milk-making tissue...why do some make very
little milk even when they do everything "right"??  It is so frustrating to
tell her I do not know what is going on.

Beyond checking her current thyroid levels...Any ideas??

Thanks-

Kathy Leeper, MD, IBCLC
Lincoln, NE

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