We have an NICU mom at our hospital whose production is very low and we are
out of ideas, so I am putting her case out for all of your ideas.  Here's
the story:  21 y.o. G1P1, delivered at 30 3/7 wks., 1 month ago.  She got
pregnant on her honeymoon, while on Ortho Tricyclen birth control pills,
which she believes were rendered ineffective because she was also on
Metabolife (?).  Anyway, 2 wks PP her baby got v. sick before her eyes, in
his isolette. He turned gray and had a temp of 100.2.  Over the next
several days she was told he had meningitis, then no, it's not that, it is
a staph infection in his bones (osteomyelitis).  He received "many tests",
including "having his bones stuck in his knees and then his thighs".  They
said he would have to stay for 6 wks of IV antibiotics.  All this
understandably stressed her terribly.  Around that time her production
dropped from ~60 ml per pumping to an average of 20 cc.  She uses the
Medela Lactina pump.  She had been producing so well, at first, that she
sometimes only pumped 4-5 times a day.  She has an hour-long commute to
come to the hospital, so it is all very tiring. Her outward response is to
be very angry.  She has followed our advice to pump every 3 hrs around the
clock and take Fenugreek (3 cap, 3x a day).  She declined to ask her MD for
a prescription for Reglan due to possibility it could cause depression. She
has a hx of depression.  We have suggested increasing Fenugreek until her
perspiration/breath/urine smell like maple syrup (an anecdotal measure we
have heard locally). Her own hx: normal breast changes in pregnancy,
spontaneous pregnancy, normally developed breasts, no hormonal
abnormalities she knows of.  Reports she has NOT had regular menstrual
cycles since age 14 when she had a severe allergic reaction and was given
heavy meds. ("20 pills a day"), mainly corticosteroids.  This mom believes
that it is the stress that has reduced her production, but doesn't know
what else to do.  She sees her baby throw up the formula and says he never
throws up the EBM.  She and her husband are a bit overweight and is afraid
formula will predispose her baby to obesity.  He has gained weight well on
the formula in the last 2 wks, and that makes her afraid he will be obese.
Please tell us any more questions you would ask or interventions you would
try.  Thank you!!

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