Oh Wise Ones ...

I have permission to post the following case history ...

Birth Weight 8lbs 6oz, lowest weight 7lbs 14oz, 8lbs 7oz at 2 weeks, exclusively nursed except for one bottle of formula at day 3.  Baby is a slow gainer and currently near the 10%, 16lbs 5oz at 9 month appointment.

Birth included an epidural and vacuum extraction, cord was wrapped around the torso 3 times.

A retained placental fragement was removed at 2.5 months (doctors apparently thought she was having her first period immediately after the after birth bleeding but she finally insisted on an ultrasound).

She has been using domperidone since month 4 initially at 2 10 mg dose 4 times a day, then at 3 10 mg twice a day and 2 10 mg the other 2 times a day.  She had dropped to 1 10 mg twice a day and recently went back to the 3/2 schedule.

I have spoken to her several times over the last 4 or 5 months, with her chief complaint an "erratic" supply which she fears will "starve" the baby.  The baby is now 10 months old and doesn't take much in the way of solids and refuses a bottle of formula.  She is meeting all developmental milestones and the pediatrician is not concerned about her gain.

I have suggested that it is very unlikely that this baby will starve herself and counseled continuing to offer the breast and a variety of high nutrition density solids.

The mother asks if she can develop a resistance to domperidone and if she should consider increasing her dosage?  She also wonders if her case is extraordinary or if this kind of supply inconsistency is more common with a similar case history.  Further, she asks if this will happen with her next baby.

As a lay breastfeeding counselor, I would, of course, refer her to an IBCLC with respect to the medication issue.  My take is this is an issue of confidence, more than supply but wonder if any of you "see" something I don't.

Thanks in advance,

Sherene Raisbeck
LLL Leader Winchester, MA

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