I have a 33 yr old G1P1, 10 days PP with low milk production. Never had 
engorgement or hardening of breasts at days 3-5. Yields 1 oz total with 
Lactina every 3 hours. Baby takes ~ 1oz directly from breast, according to 
scale. Serum prolactin level was 108 on day 9 (normal level). No significant pre 
or peri natal history. Reports breast changes during pregnancy. Denies heavy 
lochia or clots. Breast tissue appears normal, breast shape and size within 
normal limits (no large spacing between breasts). Denies hx nipple soreness, 
latch appears adequate. No malformations of baby's mouth/palate/frenulum. No 
apparent history to suggest etiology of low milk production. 

Pt now taking goat's rue tincture 1-3 ml 3X daily starting yesterday, continues 
to breastfeed, pump, and supplement. I suggested patient consider 
acupuncture.

What am I missing? Thanks for your suggestions.

Karen Wilson, RN IBCLC
Boulder, Colorado

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