On Tue, 30 Dec 2003 Jennifer Tieman, family physician, wrote:
 
'You may remember me posting about a 46 year old mom who had a baby girl by
"embryo adoption".  I just saw the baby for a 2 month check up.  Baby was
born at 6 lbs 8 oz.  At hospital discharge 4 days after birth, baby was 5
lbs 13 oz.  At 1 week (7 days) baby was 6 lbs 2 oz.  At week 2 (14 days)
baby had lost weight and weighed only 5 lbs 15 oz.  At that point, she was
encouraged to start breast compression, some post feed pumping and
supplementing with pumped milk, and close monitoring.  We had frequent
contact and baby always had adequate wet and poopy diapers and was alert and
active.  At 3 weeks baby weighed 6 lbs 2 oz, at 4 weeks 6 lbs 8 oz (birth
weight) and at 5 weeks 6 lbs 15 oz.  Mom and I were fairly happy with this
weight gain then, and decided to weigh baby in 2 weeks.  However, due to
scheduling issues, we did not weigh the baby again until yesterday, which
was at 9 weeks of age.  Baby is now 8 lbs 4 oz (3rd percentile for weight.)
 Overall, since her low point of 5 lbs 15 oz she has gained 37 oz in 7
weeks, or about 5 oz a week.  Baby looks alert and active, has about 2-3
yellow, seedy stools a day and about 6 wet diapers.  Baby is smiling,
reaching out to interesting objects, holding head and back well, and even
has rolled over front to back so she looks very developmentally appropriate,
just very tiny.  Mom feels, though, that she has to nurse the baby a lot to
keep up with her - at least every 1 1/2 to 2 hours and has occasionally
supplemented in the last 2-3 weeks with ABM, generally on the order of 6-8
oz in a week.  Mom never feels very full, except sometimes in the morning,
is able to pump only about 1 oz total (although this is in addition to
feeding the baby directly)  She is returning to work full time as a high
school teacher in 1 week.
'I can't decide if this mom and baby are doing fine, or if mom's milk supply
is just barely adequate now and is at risk for having more trouble keeping
up as time goes on.  Any opinions?'

Hi, Jennifer,
    I wonder what the mother's breast development is like?  Does she have widely spaced breasts with a flat area between them?  Is the inner lower quadrant underdeveloped?  You may be aware of the groundbreaking case series from Kathleen Hugins, Ellen Petok, and Olga Mireles on new mothers with inadequate breast development.

Huggins KE, Petok ES, Mireles O. Markers of lactation insufficiency: a study of 34 mothers. Current Issues in Clinical Lactation 2000;25-35.

If the mother is feeding very frequently, it may be that while she is doing that a limited breast storage capacity (and/or borderline amount of glandular tissue) can cope adequately.  Of course the wild card is the fact that she is facing an imminent return to work.  As a high school teacher, her work schedule may make it possible to accommodate frequent feeding/pumping when she's not in class (mosgt high school teachers have "spare" lesson periods), espec if she is able to plan childcare nearby and someone to bring the baby in - but I realise this is frequently not the case.
    Her reasons for needing to have an 'embryo adoption' to have the pregnancy could be worth looking into, if you want a reason for the struggle with milk supply. For instance, whether there was underlying infertility (and why), that isn't related to her age.  Lisa Marasco would have some worthwhile things to say about PCOS, for instance.  Lisa's excellent presentation from the 2002 ILCA conference is available on tape and would be in the 2002 conference syllabus.
    I assume you've already checked out infant-related issues, such as tongue tie, including a tongue that will protrude okay but not elevate (and thus not 'milk' the breast effectively).
    Some of the authors cited above may be on Lactnet at the moment, and may have more detailed input.
    Virginia
    in hot, sunny Brisbane,
    where the heat is enervating

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