Hey all,

The complications continue.

Short version.

Several weeks ago mom finally decided to wake baby at night (baby had
been sleeping 11-4, then eventually 11-6) so that there would never be
an interval of more than three hours at night without feeding.
Continued feeding very frequently during the day.   We were so hopeful
b/c there were definitely feeds where she took in 3, 3.5 oz and the
10-11 feed continues to be an amazing one regularly yeilding 4-5 oz.
However....overall, it wasn't sufficient looking at all factors (incl
gain)

Continued sufficient goat's rue, fenugreek etc

Tried the advice of several ibclc's -breastfeed 20 min, pump approx 20
min, feed pumped milk.  Mom has a gram scale from the lc's where she
delivered.   The bf/pump/supplement plan, as is often the case, was
overwhelming to her and not terribly effective in removing milk.
Based on weights from the scale, baby was more effective at removing
milk than the pump (though  I understand that Hartmann's research
shows a pump is more effective....someone emailed that to me
privately)

I've been pushing for her to get a thyroid workup, talk to her hcp's
about retained placenta (though that's v unlikely), get prolactin
levels drawn etc.....

Well, she did get prolactin done the other day.  27.1   Since normal
levels at 12w pp are around 100, it doesn't look good.  It it possible
that they're measuring in other units?  She didn't write down the
units and doens't have the lab report.

What is going on?  It it really that low from the poor management
early on (ie six feeds per day total with a 5h interval at night from
the 2nd night?)   She's got an appointment with her ob next week to
get a full thyroid panel, 25(OH)D, serum iron, ferritin......what
else?  I'll have her discuss retained placental fragment(s) with her
ob (though it's unlikely this far, with no symptoms, that it's an
issue)

Mom is fairly settled in with breastfeeding and supplementing with the
LA (on the plane, at the mall.....she's got it down)   There are feeds
every day where no supplementation is needed, but overall, baby takes
in 8 oz daily in supplement, had some 'makeup' weight gain, and is now
gaining in the appropriate range for age.
Aside from an initial improvement of about 3-5 oz per day (from breast
compression, optimal positioning and herbs), there hasn't been
additional improvement from waking at night to feed and/or pump, and
no improvement with the bf/pump.   Looks as though her body is firmly
set at this level.  They woke to feed/pump q3h nightly for several
weeks and are now back to sleeping 6-7h at night (though she would
have continued to wake had it been helpful).

It's late in the game, but dad finally did get on board with
domperidone.....she has realistic expectations for using it 12/13 wks
pp.

Any other helpful ideas would be appreciated.

Be well,
Katherine in Atlanta

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