I may have omitted some of the history on this case trying to be concise.  I began working with this mom when the baby was approx. 1 month old.  We worked on latch and we also dealt with reflux and no more than drops of milk expression on the left breast early on.  The only thing we can assume without an ultrasound of the breast is the existence of scar tissue on the affected side that has interrupted the milk volume related to a history of nipple piercing.  Or, perhaps a diminished ductal system on the affected side.  She is indeed a small cup size - B.  So, she could have a lack of adequate breast structure, though I believe her breasts became fuller during pregnancy bilaterally.  And, her breasts are not widely-spaced.

We've already tried the herbal remedies to increase milk supply.  We're not guessing on the lack of adequate milk volume. She rented the BabyWeigh Scale for a week at 2 different times to assess volume of intake at breast.  To test storage capacity of breast, I encouraged her to simultaneously pump breasts after feedings, which never resulted in a large volume of milk expressed.  This last time at approx. 6 months of age, average intake was 2 oz. per feeding and drops of milk were expressed when pumpings attempted; not after every feeding this time.  I don't have the baby's weight in front of me right now.

I hope I've remembered all of the comments posed and have answered them. I think we've pretty much exhausted all avenues, and now it is time to support this mom as I've previously stated and counsel her to offer solids and fluids by cup.  And, as someone has mentioned, I respect this mom's decision to not choose to pump for stimulation, and to come off of the Reglan as it is making her very tired.  She's also had a previous occurrence of PPD that I assisted her to obtain Zoloft and counseling for; she feels the Reglan may be contributing to her fatigue and depression.  This is the rationale used to counsel her to stop the Reglan.  I think I need to be available to her to come to closure with exclusive breastfeeding at this time.

Again, thanks for all of the feedback!
Carol Chamblin, RN, MS, IBCLC
Breast 'N Baby Lactation Services, Inc.
St. Charles, IL


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