I am working with a mother who has a very low breastmilk supply.  Baby was
born at 36 weeks and I first saw them at 3 days when I suspected delayed
lactogenesis. Baby is now two months.  In spite of frequent and efficient
breastfeeding, maximizing breast drainage by pumping, and a course of
sulpiride (similar to metoclopramide), the supply remains very low (approx
120 ml/24 hours).  Mother has no symptoms suggesting retained placenta, is
not taking oral contraceptives or any other meds that would decrease supply,
thyroid function is normal and I can only conclude that she has inadequate
glandular tissue (breasts are small). Baby is receiving large quantities of
formula supplements and weight gain is normal now (though low for the first
three weeks).  Mother is breastfeeding first and topping up with the
supplements afterwards and sometimes pumps in between breastfeeds.  She
really enjoys breastfeeding, is becoming increasingly delighted with the
emotional/comfort benefits, and is highly motivated to continue.

To my utter disgust she now tells me her doctor has said she may as well
*stop* breastfeeding because the formula will destroy any immunological
components in the breastmilk, so it's not worth the effort!  I want to give
him a call, ostensibly to thank him for doing the thyroid function tests,
but - being forewarned - I want to be ready to defend the benefits to mom
and baby of breastfeeding (nursing) and of the nutritional and immunological
benefits of even a small amount of breastmilk. Does anyone have any comments
(!!???!!) and especially any favourite references I could reel off.  I have
found this particular doctor "difficult" in the past so I need to be on my
toes!  Thanks if you can help.

Pamela, Zimbabwe