Wise ones, I need some help please.  An old client of mine has given birth
to her 5th baby at 26 weeks following an abruptio placenta.  Birthweight was
640 grams.  This was 19 days ago and baby is doing well, off the ventilator,
KMC, receiving EBM with fortifier.

The problem is the mother's milk supply.  She can only obtain 145mls per 24
hours.  A brief history:  First 2 children were breastfed for a short
while - usual story - no help or support.  Then mother had a breast
reduction and was told she would not be able to breastfeed.  Baby #3 was
stillborn and she had lots of milk!  Baby #4 was exclusively breastfed for 6
months and continued to breastfeed into toddlerhood.  So, we know her
breasts can do it!

The mother's caesarean incision is septic, although healing and she is
beginning to feel better.  She has been pumping from day one - every 2 hours
at least.  This is *her* schedule - she is *very* motivated.  She has been
taking fenugreek almost from the beginning and domperidone for about 10
days.  Could it be that her breasts may take a little longer to reach full
production?  I seem to remember that baby #4 was a little slow to gain
weight initially.  What else can she try?

Many thanks.
Jean Ridler  RN  RM  IBCLC
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