I am at my wits end and need suggestions.  I have a patient who delivered
her 2nd baby at Thanksgiving.  With the 1st baby, we had the same problems
but finally it was attributed to severe reflux in the baby.  She breastfed
the 1st for about 6-8 weeks with little to no weight gain.  Now  with the 2nd
baby, we have already put this baby on reflux meds, mom is pumping for extra
stimulation, breast massage, baby has good latch, and at 2 weeks had lost
over 1lb.. We then started SNS with Nutram. for supplement.
AC/PC weight shows baby getting about 15-30 cc total from both breast after
nursing 30-45 min.  when mom pumps she gets a total of 15-30 cc with a double
electric pump.
 Neither Reglan or pitocin have improved output.  She told me 2 days ago that
both her mother and grandmother have had hypothyroid for years and her
grandmother says she never produced good enough milk to breastfeed for very
long.  We had her OB run a thyroid test on her.  T3,T4, FT1 were WNL but on
the low side, Her TSH was low.  Her OB said if the TSH was low it meant she
was hyperthyroid.  She said a very large amount of her hair fell out after
her last pregnancy.  Her Pedi says that her Thyroid levels could be showing a
false normal from pregnancy.
This mother wants to breastfeed very much and is willing to try almost
anything that will increase her milk supply.  She also has a very supportive
OB & Pedi.
She has no Hx of breast trauma or surgery, she has a letdown almost every 1-2
hours and leaks milk, she is also on brewer's yeast, and reglan to try to
improve supply.

Any help would be greatly appriceated.   Have a very Merry Christmas...There
even talking of SNOW FLURRIES here in East Texas for Friday  That's the
closest we will ever get to a white Christmas, it's usually T-Shirt weather.


TIA                                       Kellie Richardson RNC IBCLC
 Longview, Texas