Hi Elise,

Of course it could be PCOS (this is not my area of expertise but there are
some good articles and archives on presentation and treatments) or other
hormonal imbalance. A  thorough history is necessary and the history may
reveal blood loss, possible retained placental fragments which could impact
onset of copious milk production. The history may also reveal birth
difficulties, preterm or near term birth, etc.

A physical exam of mother and baby are necessary as well and could reveal
hypoplastic breasts or other anatomical variation, and/or baby's exam could
reveal a problem. Sometimes the mother never "gets engorged" but did she
have any breast changes, fullness, heaviness, or firmness around day 3-6?
Sometimes the baby's feeding has been so ineffective for whatever reason,
that the milk supply dwindles quickly.

It does sound like the mother has some hormonal issues, but in any case the
baby needs to be well fed (expressed milk, donor milk, or formula), the
mother needs to begin regular efficient milk expression, and the
investigation must begin asap into possible causes for this dyad's trouble.
good luck and keep us posted.

Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA

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