Can you help me out?  I have a primip who had a 5 pound 8 ounce baby boy on
10/17/98 who was born by C-Section and subsequently lost >10% of his
birthweight while in the hospital.  I was called in to evaluate patient.  No
history of
postpartum hemorrage, anemia, retained placenta, thyroid disease.  Of interest
to me was the fact that this young woman had breast implants 10 years earlier
and was told the implants were  placed under the muscle and ducts and aerola
left intact.  Scar bore this out.  Breast upon examination were the smallest
breasts I have ever see with implants and were widely spaced apart.  I could
put a C-cup breast between her two breasts easily.  She denied changes in her
breasts during the pregnancy except for a small amount of nipple tenderness.
She had trouble getting pregnant so her OB doc did a whole blood workup on her
prior to pregnancy and apparently everything was normal (thyroid panel,
prolactin levels, hgb and hct, and HCG.)  She is now 2 weeks postpartum, on
fenugreek (9 tablets daily), and has been using the SNS at the breast.  Baby
taking 18 ounces/24 hours.  AC and PC weights on this baby only reflect
formula intake.  Baby refuses to be at the breast and fights the breast unless
SNS is there.  I do manage to express a few drops of breastmilk after heat and
massage, but just a few drops.  Mom just started Reglan 50 mg daily for one
week, which will be over next Wednesday.  She is very discouraged, breasts
still soft, and feels if no milk comes in by Wednesday she is
ready to give up.  Any suggestions besides pumping after SNS?  She is so
tired, this is difficult to do, but she tries.  TIA.  Loni Denman RN, IBCLC