Allison, I would refer her to the book Making More Milk by West and
Marasco. It will take her through all the situations which can contribute
to low milk supply and what she can do about it. We recently discussed
progesterone here on lactnet and my understanding was it probably won't
help after baby is born.

With PCOS, not only do some mothers have insufficient glandular tissue, but
they often have high testosterone levels and I don't think there is a
medicine to counteract that. Maybe an herb? She may want testosterone level
tested.

In my area, doctors often have mother on Metformin during infertility and
subsequent pregnancy, but discontinue it at birth. I would suggest she stay
on it, if her doctor approves.

While we have anecdotal evidence, recent evidence-based info from (I
believe) Academy of BF Medicine on galactagogues tells us that
galactagogues have not really been proven to help lactation much, if at
all. The basics of breastfeeding management or bf practices are the
cornerstone of lactation support: baby to breast often, effective latch and
milk transfer, draining the breasts effectively. While I'm sure if it was
me, I would be taking any and all galactagogues I thought would help. I
also think we should help a mother like this to find the easiest and most
satisfying way to mother thru bf, perhaps mainly bf with the lactation aid
and hand expressing whenever she can. Only mother knows what she can fit in
to her day and her budget, but we may have to reassure her that the basics
are the most important thing.

Laurie Wheeler RN MN IBCLC
Mississippi USA

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