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I have a mom with persistent low supply.  
*No hx of PCOS, infertility.  
*Uncomplicated pregnancy other than slighlty elevated BP at end.  C-section under epidural after "failure to progress." 
*Baby circ'd at 1.5 days.  
*Breasts did not change during pregnancy but are large, closely spaced and well formed other than mildly flattish nipples.  No visible signs of insufficient glandular tissue.  Upon palpation, can feel a little milk in the ducts.  Mom had zero PP engorgement.  

Baby was not sucking very efficiently, latch was shallow and weight gain was poor initially.  Mom didn't realize how little he was getting and so wasn't really pumping either, so got off to a slow start.  

Mom wanted to be conservative so we started with lots of pumping, hand expression, breast massage, breast compressions during feeds, improved latch/positioning and paced bottle feeding w/ both EBM & ABM to get weight up.  Mom reported being very faithful in her pumping with a new PIS and well fitting flanges but got very little increase.  Added fenugreek and blessed thistle and 10 days later still virtually no increase.  Added metoclopramide and 4 days later, still no increase in supply.  

No S/S of retained placental fragment.  Have counseled mom to ask ob for order for blood draw to check thyroid level and rule out anemia.

Baby is now 4 weeks old.  Mom and I have been working together for almost 3 weeks.

Any other ideas?  

Thanks! 

Brenda Carroll, MA, IBCLC, LLLL

www.lactationsolutions.com

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