Thanks to all who have responded to my questions re: allergy meds.  If anyone else has thoughts and you have not yet contributed, please feel free to do so.  Also, the other lactation consultant I work with and myself have noticed that many times, moms with PIH have a delay of milk coming in and in some cases, have low milk supply permanently through lactation.  The nurse I asked about allergy meds for also had severe PIH.  Day 4 - no milk - no droplets  when I attempted to manually express for her, nothing - not even moisture appeared during pumping with an electric double pump.    Meanwhile, she is stressing over this lack of production, which will make things worse.  Baby nurses beautifully, but was getting frustrated and beginning to have decreased voids at the beginning of day 3, also temp was 99.1.  So... I have her using the SNS right now, but she and her husband had trouble manipulating it yesterday.  They do ok when I'm there, but I am off for 3 days now.  I have also demonstrated cup feeding as one option  for them and they return demonstrated.  Mom is crying, Dad is nervous.  I've tried to be as reassuring and calm as I can for them.  Mom never experienced breast changes during prenancy - a few times her breasts were tender, but no enlargement.  At what point would you all suggest obtaining a prolactin level?  What is the longest period of time you have seen a delay in your PIH moms milk coming in - or even the appearance of colostrum?  I have suggested to the parents that several LC's on Lactnet have said that they have seen Fenugreek increase supply, so the parents may consider this also.
All suggestions and thoughts welcomed.
Thanks,
Dani Hudspeth BSN, RN, IBCLC
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