All right, you guys, here is my case of the quarter:

This mother came to me for discussion and support with her then 2 mos old
baby. She worked previously with another, well-known LC, but came to me
because I am closer and more convenient.

S has a history of infertility, and after 10 years and a change of
doctors, endometriosis was diagnosed and surgery done. Shortly after a
second "clean-up" surgery she conceived baby #1. This first baby had
difficulty with latch on after birth and took 3 days to get to breast,
but after that, everything seemed fine. That is, until baby developed a
sinus infection @7week and "quit eating".  They struggled to bfd, but
didn't do well. This baby also was born w/ a small head and prematurely
closing fontanel but is now ok, no problems. Between 2 and 5 mos, baby's
weight remained around 10 lbs (BW- 7-4) and was finally hospitalized for
FTT after mother became concerned and sought out help. Throughout this
time, baby had chronic sinus infection, lasting till 6 mos. Baby was
hospitalized for 1 week, force fed solids while mom bfd, and was released
at 11 lbs.  One week later, after exclusive bfg, baby again hospitalized
for FTT and continued various bacterial infections.  Meanwhile, mom's
periods returned at 10 wks.  After hospitilizations and continued weight
gain problem, mother sought out second opinion and was referred to LC,
who started her with pumping + fennugreek.  Milk supply incr some, but
supplemental ABM was still necessary. Periods continued, cramping
started, mother diagnosed with endometriosis again and had another
surgery, and conception of #2 occurred 6 wks later. Bfg was discontinued
during 6 wks post surgery because of non-responsive supply. (So far, this
looks pretty obvious, right?)

BABY #2:  Great pregnancy and birth. Baby slept first 24 hours then bfd
well, 3 hrs/day, 2 hrs/nite.  No supplemental bottles, some pacifiers.
Baby was mellow until 10 wks, when he gradually began to not bfd as well
and instead would pull away, scream, try to eat then pass gas and scream
some more.  BW 8-10,  2 wks 9-10, 2 mos 12-? (mother didn't have exact
records on hand).  Mother contacted LC, who said baby was on way to
becoming FTT, and began supplementing with ABM while pumping and doing
fennel tea, barley tea and fennugreek. Milk supply still decreased
inspite of these measures over 2 mos. Mother's periods returned at 3 mos
along with endometriosis symptoms. She was scheduled to have surgery, but
conceived #3 around 5 mos, before surgery took place. Mother did not
realize she was pregnant for two more months, but had quit trying bfg by
the time of conception.

#3- Mother educated herself on good lactation management. Early bfg
excellent, baby a good nurser. Mother has multiple MER's in 15 minute
period, baby tanks up easily and often goes 3 hours. Mother pumps when
baby skips a feed or goes too long inbetween. She feels that this baby is
her best, most consistent nurser, but she has been very nervous and
apprehensive about approaching that 3 mos mark when her periods
previously returned.

Since our Feb appt, I have tried to uncover any info on endometriosis
etiology (hormones) and possible connections to milk supply loss. One
suggestion
given was a correlation with that time frame and the theoretical
transition from hormonal to autocrine control. Reglan has also been
suggested to be added now, and I have considered the minipill (egads!) to
stave off cycles as being more beneficial than the return to normal cycles.

Mother called yesterday, is in crisis. Baby was sickly and not feeding
well for three weeks; when she finally took the baby in to the Ped, an
ear infection was diagnosed, no fevers. Baby on antiobiotics and slowly
improving, more herself, but she behaves as if in nursing strike and only
takes breast adequately 3-4X day. Ped did not weigh, so no loss
documented yet. I have instructed her to get a weight today for a baseline.
Mother did *not* pump to compensate for lack of bfg stimulation, and
feels m supply lower. Night before last she got her period back, which is
somewhat heavy and full of clots. Three days ago I had asked her to start
pumping diligently and take fennugreek capsules; she feels that this has
helped, but is very panicky about periods. Meanwhile, baby generally only
takes breast well when sleepy/asleep; we're hoping this improves with
lots of contact, eradication of infection and improved m supply.

S did well until she failed to compensate for lack of stim during baby's
illness. Possibly a self-fulfilling prophecy?  By normal parameters, I
would blame return of menses on lack of stim, but given her previous
history and failure to bring supply back, I am concerned. I contacted a
fertility specialist knowledgeable in lactation by letter, but have not
received a reply. Meanwhile, I am *very* interested in anyone's input and
ideas. I would like to collect your thoughts before meeting with her so
that I can garner the best possible recommendations. She is very
terrified of facing failure again.  If you've made it to the bottom of
this post, THANK YOU. I doubt that I'll ever have such a long one again.

Thank you to anyone who can help out.

-Lisa

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Lisa A. Marasco, IBCLC                                /  [log in to unmask]
International Board Certified Lactation Consultant    /  [log in to unmask]

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