<<She had minimal breast changes with pregnancy.>>

This is a large red flag for me in this situation.  Does she have PCOS?
Thyroid issues?  Infertility? Gestational diabetes?

Any subtle hormonal imbalance during pregnancy can interfere with the
development of alveolar tissue.

I was also just reading an article about moms delivering within 9 days of
betamethasone are likely to have a lower supply.

Anyway, is the baby at the breast??  If so, would use a device at the breast
as soon as baby is removing milk reliably well.  This mom may need it for
the long haul.

I will often offer moms labwork if they get "stuck" and do not continue to
see an increase.  Thyroid panel, testosterone, HCG, prolactin levels.  Some
want it, others do not.  In 7 years I have yet to identify anything I could
do something about.  but if you found an elevated HCG you could have her
placental fragment removed, and if thyroid is off, could get that treated.
I have found moms with very low prolactins, or a lack of rise with nursing,
but have not been able to help them.  For some moms it is comforting to find
a "reason".

Kathy Leeper, MD, IBCLC
Medical Director, MilkWorks

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