Hi Rowena, It seems although mother had prior successful lactations relative to milk supply, she did not have *uneventful* lactations, and in fact had latch problems with all children. So first I would be looking at anatomical variations in mother and/or infant that would respond to some intervention. For example, inverted or retracted nipples, tongue tie, low tone. Next I would consider mother's metabolic situation, for if the dr. feels she has PCOS, but no cysts, perhaps she has high testosterone levels or other metabolic derangements. An LC cannot assess nor treat this herself, so I would suggest mother see an endocrinologist that is bf friendly, or better yet, is there a bf-medicine person in the vicinity, even for a phone consultation? PCOS and what is now called the metabolic syndrome, appear to have similarities, and seem fairly complicated and not entirely easy to get under control. I am not well-versed in all the herbs that are used to help normalize metabolism and hormones, but perhaps a consultation with an herbalist to help her metabolism and hormones get back in shape. She should also strive mightily to eat a very healthful and whole foods diet. I would suggest a lactation aid, but I see baby is not latching. I would suggest to mother to use a hospital-grade rental pump, for approx 10 minutes double pumping, finish with 5 min of hand expression, if she can manage 8x per 24 hrs. Longer than that might be too hard for mom to do. I would suggest she continue the galactagogues, especially the domperidone, and perhaps change the fenugreek to an herbal preparation suggested by an herbalist, as I mentioned earlier. Some of these interventions might not able to be carried out due to financial constraints. In addition to this, mom can do all the skin to skin things like sling, co-sleeping and the like, to see if baby would latch perhaps with a shield (since baby is used to bottlefeeding) and mom can perhaps make some changes to how she bottlefeeds (as much like bf as possible) in the meantime. If baby latches with the shield. hopefully a lactation aid could be used at that point. This case appears to me to be multi-factorial, as most cases of low supply usually are. It would be important to not overwhelm mother with all this information, but perhaps to schedule several consultations every few days to discover and discuss all the factors. Hope this helps, Laurie Wheeler RN MN IBCLC Mississippi USA *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html To reach list owners: [log in to unmask] Mail all list management commands to: [log in to unmask] COMMANDS: 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail 2. To start it again: set lactnet mail 3. To unsubscribe: unsubscribe lactnet 4. To get a comprehensive list of rules and directions: get lactnet welcome