>>So, my question: Does this qualify as possible/probable PCOS with low milk due to hormonal imbalance? And if so, do your current recommendations involve metformin, goat's rue, and maybe domperidone? I don't even know yet if galactogogues will be necessary, because I haven't gotten a chance yet to evaluate the baby's latch or the mother's breastfeeding behaviors (responsiveness to cues, frequency of feedings).<< Elise, you don't actually have to have a diagnosis of PCOS to know that there are red flags for hormonal problems with this mom. If you did have a diagnosis of PCOS, it would probably include some known hormonal aberrations, which would be helpful. What needs to happen first, of course, is for you to see this mom, take a thorough maternal health history and infant breastfeeding history, assess mom's breasts for development, and preferably do a test-weight feeding to quantify how much milk is really going into baby at this point. It might also be helpful to have mom find out if her doctors ever had a tentative diagnosis for her irregular cycles and cysts. Depending on the outcome of the assessment, metformin may be appropriate if PCOS is a factor. Extra pumping is always helpful, though it must be balanced with the time mom spends feeding. I do also often favor galactogogues to help "turbo charge" the system, but which one(s) depends on the individual assessment. I am surprised to hear that this baby sometimes spits up when it is 6oz under birth weight at 2 wks-- that is unusual in my experience, and I wonder if it is more a result of food sensitivities in mom's diet, given that baby has had strong reactions to formulas. I would not take the presence of spitting up in this situation to imply significant milk intake. The test-feed should give a good picture. Though it could be a problem on baby's side (do a good oral anatomy and suck assessment), it sounds like it will mainly be on mom's side. If this baby is truly strongly allergic to formula, this is one of those crucial situations where you desperately want to be able to fix things. I would probably be aggressive in the care plan, including the use of galactogogues, to try to bring supply up as quickly as possible. Lisa Marasco *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] 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