I am requesting some assistance with this case, Please.

I have a client that has been exclusively breastfeeding except for an very 
occasational bottle of emb, until 3 weeks ago. Baby is 6 mos. old. Mom 
states baby started getting fussy at breast and tugging on nipple.  At first 
just at some feedings for 2-3 days, then one day she wouldn't stop crying 
even after several attempted feedings where mom says she senses baby is 
getting nothing, until she was given a 3 ounce bottle.  Mom has been working 
with another lactation person soon after this episode who has her pumping 
every 1 1/2 - 2 hours, 30 minutes long with one 4 hour break at night. she 
gets an total average of 1 oz per pumping. about 18 oz per day. This has 
stayed the same for almost 3 weeks.

She says she feels that her MER isn't working well and will often not 
let-down when pumping or nursing and then other times seems to let-down 
fine.

She has been taking fenugreek, alfafa, blessed thistle, etc. herbal capsel 
blend for over 2 weeks with out change. She appears to be taking enough as 
she has a mapley body smell.

She is waiting for domperidone to arrive.

She is not taking nor was she taking any type of medications or other 
herbals.  She is confirmed not pregnant.

Baby has stayed fussy at the breast and last couple of days won't breastfeed 
at all.

I am guessing that there is something going on hormally.  If she is to run a 
blood test, what all should be tested? What levels should we see at 6 mos 
for prolactin? oxytocin? What else?

I've told her to keep getting skin to skin with the baby especially after 
bottle feedings and not to force baby to breastfed.

Try stimulating MER by relaxation techniques and direct breast and nipple 
stimulation right before pumping.

Cut back on pumping to 2- 2 1/2 hours and a 4-5 hour break at night for 
15-20 minute sessions.

I've suggested SNS and she unsure, but may give it a try now that baby 
refuses to feed at all.

Any other ideas?

Thank you,

Zena Kay Gresham, IBCLC
Las Vegas, NV 

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