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Subject:
From:
"Kathy Amell IBCLC, RLC" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Thu, 8 Mar 2007 17:24:19 -0500
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I am currently working with a first time mother with hypothyroid (controlled 
before, during and after pregnancy), thrombocytopenia and PCOS.  Her 
current bloodwork came out WNL and a prolactin level of 100 on day 8 or 9 
(only one non stimulated w/o a comparitive stimulated level)  Well developed 
breast tissue with minimal assymetry.  IVF conception and hard start to 
motherhood C/S to deliver a near term infant then struggling along the first 
week poor feeds with resultant weight loss, a personal use pump, nipple 
damage and resultent treatment for mastitis.  

After our consult, nipples are healed, hospital grade pump in use.  We worked 
with an SNS for a week but baby is doing fine now and the SNS became a 
barrier to mom enjoying their nursing feedings confident with feedings.  Mom 
eats fenugreek in many meals and her doc has prescribed Reglan.  Her volumes 
are still very low.  At just over 2 weeks, she still only gets 15 to 20 ml.  Three 
test weights over the last week showed 6, 8 and 12 ml transfer.  With an 
educated guess at production about 170-180 per day is under what is sighted 
as low normal for day 7 in Marsha Walker's Breastfeeding Management for the 
Clinician.

Mom is considering approaching her MD about Metformin.  I have read several 
of Lisa Marasco's posts about its use (working up slowly to a typical range of 
1500 mg to 2500 mg with probably gastric side effects) but would like some 
input to address the question about how long it takes to see any impact if 
there will be any.  THis mom loves breastfeeding despite it all and we have 
gone to breastfeeding without doodads and geegaws and following with a 
supplement of EBM and ABM of her choice given by dad or family while mom 
pumps.  She verbalizes that this is far less stressful and she is enjoying 
nursing.  Baby is not giving her any problems regarding latch any longer.  The 
only thing missing is volume.  Family support, willingness to explore "one more 
thing" is there.  

Thanks for any info y'all could share.
Respectfully from sunny, warm breeze Austin, Texas...

Kathy Amell IBCLC, RLC

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