Jayne,
With mom and baby's feeding history of very short feedings and early
intro of solids, it is possible that the level of necessary stimulation
has dropped below mom's hormonal requirement threshold, resulting in the
sudden hole in the floor of her milk supply. In my experience, this is
usually accompanied by a return of menses within a few weeks of the
drop-off. Since mom has a history of some fertility problems, can you
find out more of what potential hormonal imbalances might have been in
place? Sometimes these will diminish during pregnancy but then "rebound"
in the months after birth. It may be good to re-check any of these, and
include prolactin, thyroid, testosterone, cortisol, and glucose/insulin
resistance.
I would definitely consider starting off with double-time nursings
and/or pumpings in the waking hours, plus keeping baby close in bed at
night. And, of course, a test-weighing feed would be really good to
validate mom's perceptions. I have a baby in my practice right now whose
mom has always battled low milk supply. We've had some good weight gain
weeks and some unsatisfactory ones, and mom never is sure what it's
going to be each week because baby seems happy and healthy and is not
asking for more, and in fact often refuses supplements. It is definitely
confusing when baby's behavior does not seem to reflect apparently poor
milk intake.
In the meantime, do screen for significant peppermint, sage, and
parsley. On the other side of the food coin, oatmeal may be helpful to
supply, and surely can't hurt.
If you are able to validate mom's concerns, a pharmaceutical or herbal
galactogogue may definitely be helpful to add to the above.
~Lisa Marasco MA IBCLC
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