An ongoing puzzle:

A mother with Type 1 diabetes delivered 2 3/4 months ago, with greater than
average blood loss.  Her baby, born 3 weeks early at 5 lb 10 oz (the 5th
percentile), paralleled that 5th percentile line from a point 8 oz below it
for a month while we struggled to get her supply up.  At a month his weight
stalled and she began supplementing with a friend's milk - first 6 oz a day,
then 4 oz a day as the friend's ability to donate diminished.  With the
extra milk, he began averaging an ounce a day, and climbed to the 10th
percentile.  Gaining at an ounce a day, he should continue to climb slowly.
She has been adamant that formula not be used if at all possible.

Mom has had episodes of increased fullness (suddenly "hard" breasts despite
a stable and very frequent nursing pattern) that have seemed to ratchet her
supply slightly upwards each time.  She has *slightly* "childish" breasts,
with lots of stretch marks.  Her weight is normal and her blood sugar
control is excellent.  I've been hoping her low supply was related to the
blood loss and subsequent low blood count, and not to primary insufficiency,
and the gradual improvement keeps us both going.  There was nothing in her
history until the next paragraph to make us think there might be a retained
placental fragment.  Now the really odd part:

She ultimately bled for 7 to 8 weeks.  About 2 weeks later, she "started her
period".  It seemed to her to be a normal period.  16 days after the start
of that one, she bled again.  We reviewed the notion of a placental fragment
and she called her OB's office to be told, basically, sometimes this happens
but call us if you hemorrhage.

Two days before her most recent bleeding, her supply ratcheted up again and
she had her first totally normal test weight - 2.6 oz after never having
exceeded 1.7 oz before.  Her supply has seemed pretty good to her since
then, though he's not yet refusing supplements and she's not stopped
offering them.  I don't have recent weights for him (she's been using the
scale herself).

There've been other problems - thrush, vasospasms, a rather persistent plug
that began around the time of the most recent bleeding.  This mother has
been through the mill.

What do you think is going on?

Diane Wiessinger, MS, IBCLC  Ithaca, NY

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