Hi Wise Ones, I have been working with a mom for 2 mos. now that is still experiencing very low milk supply.  History--mom is 35 yo with 4 other children that were all breastfed exclusively for aprox. 6 mos.  She was diagnosed with a possible accretia (sp?) by US at around 28 weeks.  Mom had lots of problems with pregnancy--bleeding off and on, treated with brethine for premature labor, and several UTI's.

Mom went into labor at 36 weeks, and the suspected accretia resulted in a c-section (her second).  OB performed a hysterectomy, ovaries and partial cervix left intact.  Mom experienced a post-partum hemorrhage, and required 3 units of blood.  She also had a severe UTI in the hospital.

Initial breastfeeding went pretty well, but was soon apparent that baby was losing too much weight.  Mom started taking alfalfa (for iron and milk production) and fenugreek.  Supply only increased slightly with addition of herbs, pumping and frequent nursing.  Baby has been supplemented with Alimentum since about 3 weeks of age.

Baby is now 2 mos. old, and is gaining aprox. 1/2 oz. per day with breastfeeding and supplementation.  Suggested mom talk to OB about doing thyroid levels and prolactin levels.  Test results came back today and although I was not privy to the numbers, OB told mom that thyroid levels were fine.  He also stated that her prolactin levels were high, but he said this would be expected with a breastfeeding woman.  Her iron is also fine.

This mom wants desperatly to breastfeed this baby and feels horrible that her body has failed her.  We have tried everything that I know to offer (she will do anything).  I was concerned about Sheehans since mom has history of hypotension (bp usually around 100/60 but has been as low as 80/50), the postpartum hemorrhage, and just this week mom stated that all of her underarm hair is gone!  OB explained all of this as being stress related, but I am just not convinced.

I have worked with moms that have suffered severe postpartum hemorrhage, but they have always seemed to get their supply back.  Is there something here that I am overlooking??  Baby has become a bit lazy about nursing, usually nurses about 40 min--with lots of breaks.  Baby has been checked for metabolic disorders and seems to be healthy.  Mom initially tried SNS, but with 4 little boys and the new baby, found it overwhelming.  Any and all advice appreciated.  I just want to make sure that I have exhausted all possibilities.
                                           TIA,







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                                   Pam Holland, BS, IBCLC
                                        Savannah, GA