I'm working with a mother of a 3-month-old girl through the WIC program
(nutritional program for low-income mothers in the US), where I'm a
lactation intern. Have the mom's permission to post.

As you're reading this, consider this about the mother: she has previously
been diagnosed with myasthenia gravis, vitiligo, and alopecia--all
autoimmune and varying in severity in her life. Fortunately, the myasthenia
has been in remission since she was 13, though her pregnancy was considered
high-risk because of it. She did have two very early miscarriages prior to
carrying this daughter to term. She does not consider herself to have
difficulties re: fertility, though, as the time frame among these three
pregnancies was not large.

Baby latched soon after birth but breastfeeding quickly became painful.
Baby hasn't latched successfully since leaving the hospital. Baby had a
tongue tie clipped on day two--had no impact. Mom still tries to latch
daily and does skin to skin to encourage it. She has been exclusively
pumping since two days after birth. We've worked on latch to no avail. Baby
won't do SNS at breast either. Baby does get 'breastfeeding-friendly'
bottles, though as we know that doesn't matter for lots of newborns, in
terms of nipple preference.

The mom has been a faithful pumper. She used hand expression (using videos
from YouTube) and a manual pump for a short while when her Medela double
electric pump (purchased new) failed on her. In that time, she came to WIC,
and we lent her a hospital-grade pump.

Here's the primary issue: pumping every two hours, day and night, the mom
had plentiful milk in the first month--enough to freeze extra. She was
pumping 3-5 oz. at a session. Between week 4 and week 5, her milk supply
dropped so that she was pumping 4-5 oz. per DAY. It happened over the
course of a week. The mother was mystified. There were no apparent life
changes in that time. The mother shows dedication to every effort we make
at trying to increase her supply. We've added hand expression, breast
massage, galactagogues (though fenugreek upset her baby's stomach),
endorphin-raising videos during pumping sessions. . . . She now gets 1-2
ounces more per day after all these efforts. So her daughter is mostly
receiving formula. Unfortunately, she spits up a lot now.

Against her wishes, mom had a Depo Provera shot three days after her
daughter's birth, the same time she received several vaccines. Hospital
scared her into having the Depo, though that's a separate story. I've asked
a number of LCs and have gotten anecdotes of milk supply dropping up to
weeks after a Depo shot and then improving around 12 weeks in. (Mom will
not be getting a new shot.) This mom's supply has not increased yet, though
she's at week 14 now and I'll see her again tomorrow.

I've been researching myasthenia and autoimmune clusters to see how they
could be related to the decrease in milk supply. For two months, I've been
encouraging the mom to get a thyroid test to see if she has developed
Hashimoto's postpartum. Unfortunately, she has a $5000 deductible on her
Kaiser (non-group, under Obamacare) insurance, and because she is not
working after her daughter's birth, even relatively inexpensive medical
tests are out of reach right now. She's been trying to get back on MediCal
(state insurance), which her baby still is. I was hoping that she would be
able to get her thyroid checked as part of a well visit that might not
trigger the deductible, but I haven't heard yet whether she has been able
to work that out.

I'm reading up on myasthenia, vitiligo, and alopecia, as well as autoimmune
clusters in general, and their impacts on breastfeeding. Finding a decent
number of anecdotes around myasthenia but not much in the way of research.
I've been reading through the LactNet archives, as well.

If you can direct me to any findings, or even tell me if you have a gut
instinct about what may be going on/what might help, I'd appreciate it.

Sally
Sunnyvale, CA, USA
Lactation student at UCSD

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