Hello Lactnetters, Case: Advanced maternal age G3 P3, older sibs in their teens. Mom had ended up giving ABM at 3 months and 3-4 weeks respectively. Her delivery was par for the course here, epidural but no other interventions. Good post partum course. Inf latched well per mom and was nursing at least Q3H during hospital stay. I received a call from the pedi at 5d visit requesting SNS (BW was 8#1oz, d/c wt at 1 d 7#13 - day 5 7#2.7oz all exclusively bf) they purchased an SNS mom deferred consult at this time (is a NICU nurse). Next day, after supplimenting weight was 7#7.6oz. One week later mom called for consult inf had increased to 8# 1.8oz BF first for 30+ min both br then supp due to hunger signs 6-8 oz daily. At consult the next day mom was well rested, non-smoker, no medications other than prenatal vits. Good interaction with baby, inf was quiet and alert ac wt was 8lb2.6oz pc after 45 min feeding using both br transferred <1oz still showed strong hunger signs. Mom supplimented. During feeding inf had good latch, mom with bilateral let down, milk easily hand expressed - good latch mom handled inf well, open pause suckling suck to swallow only 3/4:1 most of feeding in my estimation. Mom did not appear tense or excessively anxious - had pretty much accepted matter of factly the apparent insufficiency. She wanted to know how to increase. Plan was more freq feedings (was demand feeding roughly Q3), wear the baby, fenugreek/mother's milk tea, for 48 hrs pump for 10 min after feed for stim. and ad lib suppliment to meet inf need. Mom still had sns but had switched to A---- btls. Thyroid studies done during preg were WNL, had exp. only mild engorgement, no hx of surgeries, nl br development, 1st trimester br changes noted. Both of mom's sisters had similar experiences with breastfeeding with early suppliment. We discussed having prolactin levels drawn and thyroid studies redone, possible retained placental frag (though the history with 2 other kiddos made me doubt this possibility) and mom was to talk to the nurse midwife she used and get back with me if they decided to do the level. She called back 4 days later reported no appreciable change in supply very little to no residual milk with post feed pumpings but inf still showing hunger signs after bf. Had had prolactin level drawn (unstimulated 89) no thyroid done at this time. Had added Reglan but had used this with last bf experiences without increase in milk so she wasn't optomistic. At this point was willing to give another week to her efforts. Yesterday, my partner saw this mom and test wt indicated again about 1oz did have 1/2:1 auck/swallow for initial burst of suckling <3-5 min. Mom has had a stimulated prolacting level and the thyroid studies done and is waiting on results. Whew -- ? What next? Mom has indicated that she has followed the plan. We had suggested seeing an IBCLC for a second opinion and mom deferred. Any suggestions? Her family is very supportive as is her HCP, mom has surpassed her 1 week self limit to try, so she does appear motivated to affect change. Your input is appreciated. Hopeful, Kathy Amell LVN IBCLC hopeful *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html