(My apologies if this has shown up already.  I sent it 2 days ago but it has not
shown up on my digests.)

I'm currently dealing with a 2-week postpartum mother with an inadequate milk
supply and wonder if anyone has any suggestions (especially our wonderful
physicians).  My partner saw mom and baby at 5 days because phone follow-up had
been suspicious.  Baby had lost about 12% of body weight and was admitted for a
high bili and dehydration.  Mom was still "waiting for her milk to come in" on
day 6 when I saw her, but what she was pumping looked like milk to me--trouble
was, she was (and still is) getting a max of 10cc with every 2-3 hr. pumping.
Baby has gotten a max of 8cc when we've done incremental weights.  For the last
week she rented a "big" electric pump and pumped after nursings to try to
improve the supply with no effect.  She has just returned the pump because of
cost factors--baby is continuing to nurse before mom supplements.

She's 38 years old, single, this is a first baby, no problem getting pregnant,
on no meds, has no pre-existing medical conditions, had a small increase in
breast size during pregnancy, breasts appear normal in shape.  She did get a
shot of depo-provera before discharge, but this is not uncommon here and we
don't normally see problems.  We asked her OB to check a bit further, so on day
9 he ran a prolactin and TSH.  TSH was 1.77 UIU/ml (normal listed on lab slip
was .40-4.70) and the prolactin was 58 ng/ml.  Looking at the values listed in
Lawrence, it seems like a baseline prolactin still ought to be well above 100 at
9 days, so she's going to try metoclopramide to see if it helps.  I know this is
not a long-term solution.

Are there any other lab values that should be checked?  What do the rest of you
do in a situation like this?  Thanks for any help.

Becky Krumwiede, RN, IBCLC, Wisconsin
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