PTP

I am working with a mom who has done everything we can think of to increase her low supply. She and her baby have had help from birth. His birth was traumatic and he has had a lot of skilled body work. Latching was extremely painful until after several body work sessions. Baby has normal tongue function. Latching is still painful at times but Mom reports some comfortable feeding sessions with swallows and Baby seems satisfied. She has used a supplementer at the breast with some success.

Mom has normal looking breasts, has no obvious signs of insulin resistance, no PCOS.

Mom has a very delayed let-down. She will pump for 7 minutes before milk starts to flow, then it never stops no matter how long she pumps (she has pumped for a full hour before). It doesn't come fast but it does keep coming. She pumps 8x a day and removes 6 ounces. Baby is also breastfed 8x a day and supplemented by bottle afterwards or sometimes with supplementer at the breast. She is using a Medela Symphony. Baby is getting the majority of his nutrition from formula despite all Mom's efforts.

Mom has had her thyroid levels tested (normal) prolactin, progesterone and testosterone are within normal levels. She has taken More Milk special Blend with some success.

When she started Domperidone, she started getting lumpy tenderness in her breasts. The lumps and tenderness would resolve in one area to reappear in another. It felt like plugged ducts but not as painful. She has some success with increased supply but the lumpiness is concerning to her.

Any ideas why this is happening? My first thought was that she has low storage capacity and the Dom stimulates her milk supply above what she can hold in her breasts. More frequent pumping may be helpful but pumping takes her a lot of time due to the slow let-down. She has also tried fennel for the let-down.

Laura Spitzfaden, LLLL, IBCLC

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