Hello everybody,

I seem to have a cluster of lactation difficulties, here. Some solve
pretty easily, but others have me stumped. So, I am calling for you all...

Case # 1:
Mom on Clomid (for stimulation of ovulation) for 3 years. Finally starts
a pregnancy, but has spontaneous abortion due to lack of progesterone.
Back on Clomid, has a pregnancy that she "keeps" with progesterone orally
and bed rest. Has her baby but, you guessed it, no lactation. Drops of
colostrum, progressing to barely 10 cc of transitional milk. Pumped from
the start, gives extracted milk and ABM with SNS. Followed by a
good LC, good hospital support. Domperidone (Motilium) 10 mg for times a day
prescribed
(by me) 4 days ago, quantity went from 10 to 15 cc, and stayed there.  Of
course, she is also taking fenugreek and milk thistle capsules, resting a
lot... but getting a bit desperate! TSH normal, and prolactine way higher
than normal for non-breasfeeding people (though I do not know of the
normal values for bf women). She will hang in there until next tuesday,
but will let it go after. By the way, she also suffers from migraine and
irritable bowel syndrome for which she is followed by a neurologist and
gastro-enterologist; takes no medication for the moment, and was fully
aware that motilium could have negative side-effects for these
conditions.  What else can we do ?

case #2:

Mother of a 6 months old. Has noticed since the third month that baby was
gaining very slowly andlooking thinner, but was told to give a bottle.
Discovered LLL and finally got some support. When she saw me, baby was
thin but alert and in a good mood. She had just started to supplement via
SNS adn giving cereals.  Baby was very active at the breast, latching and
unlatching, unhappy and agitated. Better with SNS for a couple of days,
then back to agitation. Gained 600 gr. (20 on) in one week, while I was
testing his urine and blood; the tests were normal. Mom has very little
MER, and it takes several minutes for one to come. Though she had felt an
increase in production with the SNS, she decided to start pumping 3 days
ago, and also started fenugreek and milk thistle; declined Motilium, as
she is wary of all medication. But baby has decided to refuse the breast
yesterday. She is desperate, badly wants to keep on bf. Suggestions ?

Louise Denhez, M.D., M.P.H
Montreal, Quebec, Canada