Just when I had decided to go nomail for a while and a much needed rest, here is a case that has me stumped. I already searched the archives, but would need your collective wisdom to put it all together: Mother is a nurse, has her fourth child. Breastfed "successfully" her three others. The quotation marks are there because the babies were not gaining weight too too well, but there was no immediate danger to their health, and Mom weaned on her own accord at 4-5 months. Now, it is important to say that these three episodes took place with breast implants. Divorce, takes the breast implants off, remarriage, fourth baby. Unmedicated delivery, but baby is hospitalized for dehydration at day four, while Mom has an "enormous" engorgement. Rents a pump and expresses 2 ounces in the first sitting, then a little bit at a time. Baby comes back home, Mom sees an LC (certified) and does everything well, supplementing with finger feeding and bottle occasionnally, the LC not convinced that confusion exists. From day 1, baby not vigorous on the breast. Seems to have taken the breast better on weeks 5 and 6, but rapidly seems to not have enough, and is jittery on the breast. Now, baby is 2 and a half months, she is pumping every 2 hours for 10-15 min. at a time, after each feed or just about, baby is on the breast only all night long, one side after the other, and still needs about 6 ounces of supplementation with formula. We started domperidone (motilium) 4 days ago, with no change whatsoever. The lactation aid is now the only supplementation method, but does not work so well: baby takes the breast when the bottle is squeezed and he feels milk in his mouth (he also still does not latch on well, waiting for the milk to come, and suckling lazily) She feels the ejection reflex, but sees very little squirting from either breast. I asked for a TSH, but, frankly, I wonder if the removal of the breast implants did not severe breast tissue... Her surgeon says no... What do you all think ? What else could we do ? How long does Domperidone take to work ? (my experience with it has not given spectacular results, but is also quite limited). Is there hope for complete breastfeeding ? Louise Denhez, M.D., M.P.H Montreal, Quebec, Canada