Hi Laura,
Regarding which lab work to request on this mom with low milk supply, don't forget to assess iron status. I'd recommend ordering a serum ferritin, but you must make sure that the mother has eaten a normal amount of calories the day before, and is not in fasting status or dehydrated when she has the labs drawn. If she is fasting, the ferritin will be falsely elevated, and you may miss a low ferritin.
According to an unpublished study of NHANES data, hemoglobin/hematocrit miss iron deficiency over 50% of the time, so while you may want to test hemoglobin and hematocrit, don't assume that "normal" values mean that she is in good iron status.
If she turns out to be iron deficient, a supplement of chelated iron would be in order. It's important to start with a small dose. I'd recommend that she watch her stool color, and if it turns very dark or black with the iron supplement, then reduce the dose. There is no point in giving lots of iron only for it to be lost in the stool.
Carolyn Donohoe Mather, MAS, RDN, LD, IBCLC
>
>
> ----------------------------------------------------------------------
>
> Date: Sat, 26 Nov 2016 12:11:27 -0500
> From: Laura McCormick <[log in to unmask]>
> Subject: Hormonal panel
>
> permission to post -
>
> Mom, trim, very fit. History of 7 miscarriages (one at 15 weeks), one older child (2 yrs) and a 26-day old boy, 9 lb 6 oz at birth. Took progesterone during first trimester with both live births and the 15 week pregnancy. Mom’s breasts were always a small A cup, now a fuller A cup, symmetrical, not far set. Large, long nipples. No fullness or engorgement after either birth. Mom grew up on an apple orchard with exposure to farming chemicals. Older child has unrevised lip tie, mom nursed, pumped with hospital grade pump for at least 4 months, pumping 10-12 oz per day at most, baby stopped nursing at 9 months. Little boy nurses every 3 hours, for one hour and takes in 1 oz at breast, then about 2 oz of formula/expressed milk by bottle, paced feeds, within 10 – 15 minutes. Mom pumped with consumer grade pump post-feeds getting about .5 oz. She is now on day 11 of a 14 day course of reglan, seeking a script for domperidone. Also, taking MotherLove’s More Milk Special Blend tincture. Baby had his lip tie and posterior tongue tie revised 4 days ago, beginning CST today. Also, beginning today, pumping with hospital grade pump every 90-120 minutes, feeding baby on cue with supplement and ‘finishing’ at the breast.
>
> For a hormonal panel, is this what we should look at?
>
> Androgen
> Estrogen
> Progesterone
> Prolactin – pre and post drainage
> Testosterone
> Thyroid
>
> Is there anything else we should look at? Thank you for any input or suggestions.
>
> Best regards,
> Laura McCormick, IBCLC
>
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