A mother was referred to me by her midwives.  She delivered her 8th
child
July 25.  All other children were successfully breastfed.  Baby girl
weighed
6#12oz at birth, weighed 6#7oz  on August 17 (3wks).  Mom nurses
15min. side every hour on alternate sides.  Mom has known of low thyroid

condition for 3 years, has not taken meds.  With last child (now 3
years),
she nursed for 2 years, then noticed breasts were "smaller than they'd
ever
been".  She noticed no breast changes in this pregnancy.

To complicate, baby has bacterial urinary tract infection.  Baby girl
has
poor muscle tone, weak suck, feeds on nipple if not encouraged.  More
than 8 wet diapers, clear urine, but stools are mostly stains in diaper
with
one filled diaper per day.

Also, entire family is living with a brother while their house is
getting water
and electricity.

When she left us last week, she was to start her thyroid meds and baby's

antibiotic right away.  She had instructions for good latch and to allow

baby to end feeding.  She was told ABM supplementation may be
necessary.  Pedi wanted to see baby gain 7 oz in 7 days.

On follow-up, 8/21, baby had gained 4 1/2 oz in 4 days.  (Baby at 4 wks
has just regained birthweight.)  Mom had not filled prescriptions for
thyroid
medication and baby's antibiotic.  Baby was hypotonic - enough to
concern
me despite the weight gain.  I suggested ways to supplement baby at
breast
with EBM or ABM using dropper or curved-tip syringe.  Mom agreed to
use EBM only, refused ABM.  She said she would fill prescriptions and be

back Thurs. or Friday for weight check.

Question:  Did she experience involution of breast after baby #7?  Do
mothers ever get a full supply after that with future pregnancy?  Is it
related
to thyroid, or separate?  And about her compliance - I'm sending a f/u
report to her Pedi and am in touch with her midwife.  How can I be more
aggressive with mom?  I feel I have been as explicit as possible with
the
necessity of increasing calories right NOW.  TIA.

Jeanne Fisher
Austin, TX

P.S.  Can anyone tell me how to set Microsoft Word for Windows 2 to a
setting that gives me better line breaks on LACTNET?  Thanks, JF