I had the unfortunate responsibility to tell a mom yesterday that it is
unlikely that she will be able to produce milk for her baby.  She came to me
wanting a prescription for Reglan. She's been pumping q 3 hrs. and taking
Fenugreek. Supplementing with 4 or 5 ounces ABM after breastfeeding. She said
"I have never even wet the pump."
The history alone was a disaster: 34 year old mom. Fertility problems; needed
clomid to get pregnant then progesterone support for the first 12 weeks
(previous history of early miscarriage). Questionable pituitary function, low
thyroid function, no breast changes in pregnancy, no fullness post partum.
Labor: 26 hour induction with a 4 hour pushing time, meconium aspiration, cord
around the neck tight times 2.
Post partum course: Maternal post partum hemorrhage (Hgb went to 7). Baby and
mother treated with IV antibiotics for confirmed for beta strep infections.
Pumped q 2-3 hrs starting 6 hours after the birth. First breastfeeding at 7
days of age.  Baby will latch on and suckle but there are no swallows. Mom
said she had bad post partum depression.
All this had me holding my breath, then the other shoe dropped. Mom had a
breast reduction for CYSTS (?) in the lower half of her breasts in 1986 !  Mom
said she was initially upset that the surgeon botched the job because her
breast size was so uneven. She went down 1 cup size from a "C" to a "B" cup.
Then I looked at her breasts and have never see incisions like these. There is
a straight scar from the areolar nipple junction down to the chest wall, half
circle scars around the base of the areola then again at the base of both
breasts. It looks like a double anchor.  I  felt like the surgeon just carved
her up and for what--cysts? It doesn't make sense.
 It looks like the surgeon only took tissue from the lower part of the
breasts, (the top half of the breast is rounded normally.  I am wondering if
the incisions in the areola mean that he made her areola smaller too. Mom
didn't think they were smaller after the surgery. What would be another reason
for such an odd scar line?
Top it all off the surgeon in 1986 told her he didn't disturb the lactating
tissue in her breasts or remove the nipples so she would be able to
breastfeed.  I felt so bad for her. I gave her the option of using an SNS and
continuing to comfort nurse.
I don't know exactly what to blame hormonal disaster or the surgery or both.
My physician mentor is having tests run: thyroid panel, prolactin and
progesterone levels. Is there anything else that might help?
Marie Davis, RN, IBCLC