Hello,

I have a patient that I am seeking some advice on.  A 40 year old primip, long induction at 41+, emergency c-section.  Normal newborn.  Normal breast changes during pregancy, growing in size after delivery, per pt.  Son very fussy at breast, incorrect latch, nipple damage.  Worked with LC's in hospital, discharged to home with hospital grade pump.  Saw at 5 days post partum.  Breasts normal, firm to touch.  Recommended increased skin to skin and allowing baby at breast when relaxed, warm compresses, warm showers, pumping 8 times per day, hand expression.  

Expressing about 4-5ml per pumping at day 5.  Day 6, during one pump, expressed about 50ml and then the next 25ml and then after that no more than 10-12.  Day 7, no change.  Started fenugreek and is going to start Mother's Love more milk.  Should she be considering an rx galactagogue this soon?

Plan on calling OB tomorrow to send for blood work on thyroid, hormone levels.  Should she be considering an rx galactagogue this soon?  Should she have an ultrasound done to r/o retained placenta?

Am I missing anything?  I want to be very proactive about this and not wait to see what happens.  

Thank you so much for any advice or guidance.  Feel free to email me directly  [log in to unmask]

Fondly,
Laura Miller, RN, IBCLC

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