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Date: | Thu, 8 Mar 2007 17:24:19 -0500 |
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I am currently working with a first time mother with hypothyroid (controlled
before, during and after pregnancy), thrombocytopenia and PCOS. Her
current bloodwork came out WNL and a prolactin level of 100 on day 8 or 9
(only one non stimulated w/o a comparitive stimulated level) Well developed
breast tissue with minimal assymetry. IVF conception and hard start to
motherhood C/S to deliver a near term infant then struggling along the first
week poor feeds with resultant weight loss, a personal use pump, nipple
damage and resultent treatment for mastitis.
After our consult, nipples are healed, hospital grade pump in use. We worked
with an SNS for a week but baby is doing fine now and the SNS became a
barrier to mom enjoying their nursing feedings confident with feedings. Mom
eats fenugreek in many meals and her doc has prescribed Reglan. Her volumes
are still very low. At just over 2 weeks, she still only gets 15 to 20 ml. Three
test weights over the last week showed 6, 8 and 12 ml transfer. With an
educated guess at production about 170-180 per day is under what is sighted
as low normal for day 7 in Marsha Walker's Breastfeeding Management for the
Clinician.
Mom is considering approaching her MD about Metformin. I have read several
of Lisa Marasco's posts about its use (working up slowly to a typical range of
1500 mg to 2500 mg with probably gastric side effects) but would like some
input to address the question about how long it takes to see any impact if
there will be any. THis mom loves breastfeeding despite it all and we have
gone to breastfeeding without doodads and geegaws and following with a
supplement of EBM and ABM of her choice given by dad or family while mom
pumps. She verbalizes that this is far less stressful and she is enjoying
nursing. Baby is not giving her any problems regarding latch any longer. The
only thing missing is volume. Family support, willingness to explore "one more
thing" is there.
Thanks for any info y'all could share.
Respectfully from sunny, warm breeze Austin, Texas...
Kathy Amell IBCLC, RLC
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