I've been contacted by a mom who has been searching for help for over two
years regarding a chronic breastfeeding problem.  This is a para 5,
gravida 4 mom with a now 7-week old baby who is panicking after seeing
the same old pattern begin again.

With each baby, she started breastfeeding and was initially very
successful, with babies gaining nicely and turning into fat little
cherubs. However, her menstrual cycles returned at about 8 weeks pp, even
with increased nursing of up to 12-15 times a day.  Once her cycles
return, an ominous pattern sets in: baby becomes fussy, stools space out
(which can be normal, BUT----), weight gain falls off the next couple of
months, supply diminishes. With her second baby, she pumped with a
hospital grade pump for extra stimulation between 3 & 4.5mos, but said
that she "could not let down" and ultimately quit due to inadequate
supply.

With #3, baby's growth plateaued at 3 mos. Mom was under a lot of stress
due to dad's unstable work situation, and she thought maybe that was the
problem. They practice NFP, mom conceived at 3.5 mos pp but miscarried 6
weeks later. Kept nursing through all of this, felt that baby was not
growing properly around 5 mos and contacted her ped, who noted drop on
growth chart but was not alarmed.

[Here's a great part I know you'll all appreciate] A friend told this mom
that stress was probably her problem and gave her "Babywise" to fix her
life.  Mom reported to me that within 3 days, her baby became seriously
dehydrated, with sunken fontanels, and she quickly ditched the book.

She then contacted LLL, has tried several "natural" remedies such as
alfalfa and blessed thistle, with little result. At 10 mos she had
metoclopramide prescribed and said her milk supply returned abundantly
overnight, only to drop off after her 10 day course finished. Finally was
put on metoclopramide long term and breastfed till 14 mos, when her
prescription expired, and also at which time she developed depression and
wanted to take anti-depressants. Used goat's milk to supplement the
deficit in her supply over the several months.

Now, at 7 wks pp with baby #4, her cycle has just begun again, and she's
anticipating the worst.

Add'l info: mom has fought multiple yeast infections for several years.
Someone told her that high estrogen can cause yeast and thought, due to
the milk supply decline, that perhaps this might be the problem. Mom had
her thyroid levels tested before pregnancy [normal], and recently [low, I
don't know how low].  While thyroid may be a contributing factor, it
seems like more may lie at the roots here.  In family hx, her mom had
fertility problems due to endometriosis, and grandma had something like
20 pregnancies with 6 live births, also apparently ultra-fertile.

She probably needs a more thorough blood panel, but what?  Prolactin and
thyroid, definitely; insulin? testosterone? estrogen? suggestions?

I'm looking for any and all input to help solve this mystery for a woman
who desperately wants to give her baby a longer breastfeeding experience.

TIA,
Lisa Marasco, BA, IBCLC