Hi Anne,
I agree wholeheartedly with Nina that the "quality" of the milk is not the
issue.
Nina also made some very good points about why the preceding babies might
have had low gain.
The mother's thyroid medicine dosage is not so much the issue, you would
want to know what are her serum levels of the thyroid hormones. I am not an
endocrinologist, but perhaps the mother needs to see one, as she also has a
diabetes problem, and maybe other more pervasive hormone derangements due to
the thryoid being removed. This sounds more serious than the "usual"
hypothyroid condition.
You say the mother's supply is not the problem, perhaps not, but I bet the
baby's total volume intake is low. In 25 yrs, I've never seen a case of poor
quality of milk, but always low intake. If it's not a mommy problem of low
supply, and I wonder if indeed it is, then it's baby's ineffective or
infrequent feeding, or both, or a medical condition like sepsis or cardiac
disease. Nina covered this well. I've had mothers report by phone that their
milk came in, but on visual inspection and palpation, in person, the supply
is quite quite low.
of course, tongue-tie and other oral anomalies can lead to ineffective
feeding, and can run in families, but seems unlikely with last 3 babies all
having this. Were the last 3 babies in any way different, like prematurity
or 37 wk'ers? When was her thyroid removed, and does that surgery correlate
with the slow gainers? Also, If it's a disease process or genetic problem,
it would not really improve with the addition of solids.
I would expect a multipara like this mom, with many lactations, to have an
abundance of colostrum and get her milk surge very early like day 2. You can
immediately assess the baby's feeding effectiveness and general tone and
health, and you should be able to very quickly assess if it's a supply
problem or not, and go from there.
Laurie Wheeler, RN, MN, IBCLC
MISSISSIPPI USA

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