Dear Ladies,
I need your wise wisdom with this one. I had a phone call yesterday from a mother and I'm stumped. She has given me permission to post this. She has a 4 week old baby and it's her 8th baby. She is a very experienced nursing mother. With her sixth baby she suffered a very bad bout of plugged ducts and mastitis when the child was about 9 months old, which she never seem to completely recover from. She continued to have problems with plugged ducts in her right breast, in the same area with the 6th baby. So an LC recommended lecithin, it helped greatly with the plugged ducts. But if she stopped taking the lecithin, the plugged ducts would occur again, so she continued taking lecithin and breastfeeding her 6th baby. The baby was eating a solids at that point and eventually weaned at about 12 months, having some breast and lots of solids. She began taking lecithin about a month before her 7th child was born and for some strange reason, even though she had
 successfully breastfed 6 babies that baby became FTT. It was a normal birth, no complications, actually all of her children have been born at home with a CNM. At five days after delivery the baby at lost 18% of his birth weight and look emaciated. I didn't see her with that baby, but the Ped recommended breastfeed first and then follow with formula. She continued to partially breastfeed for about 2 months and then the baby refused the breast and she went to formula only after that. Now she has had her 8th baby and it's the same exact story again. Normal birth, exclusive breastfeeding, taking lecithin, and we have a FTT baby again. I have heard that lecithin "thins" your milk to prevent plugged ducts, but I'm very concerned that it may be a factor in this infants weight loss. It's seems very odd that her babies have gained weight well until right up until she begins taking the lecithin. And she is producing milk, yesterday and fed the baby for 40 minutes
 and then pumped 40 ml. Also, at our office we ran blood work, no hypothyroidism, no other meds or medical conditions. She has 8 kids but denies excessive stress (except about this) she has a very supportive and helpful husband. She denies depression, no h/o PP depression. Some of my questions are:

Has anyone seen lecithin associated with slow weight gain? Is lecithin affecting the proportion of foremilk to hindmilk?  It seems as though we have damage in that area of the right breast, probably scarring of a duct - is there any type of surgical repair that could be done? What recommendations do you have for a mother who had damage or scarring to part of a breast? My gut tells me have her stop the lecithin, but don't know what to do about the plugged ducts. What about the possibility of her developing a milk supply only on the left breast and letting her right breast stop milk production? I don't have the equipment to do a calorie count on her milk, but maybe could refer her to someone who can. I would be very curious about the caloric content. Thank you for any help you have to give. 

Tricia Shamblin, RN, IBCLC

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