Barb,

<Anyway the Dr mentioned to me something about prolactin injections this
time if she doesn't get a good milk supply.>

How marvelous that the MD approached you to discuss it! What a wonderful
opportunity for you to contribute to the physician's knowledge about the
physiology of breastfeeding!

His/her current knowledge is very sketchy, or he/she would not jump to
conclusions so quickly and fall back on standard "there's a medication to
fix anything" type advice.

It is well documented that prolactin levels begin to increase within a
short time after each good latch/nursing. Also, that a pumping with a
double breast pump causes a higher surge of prolactin levels than pumping
with a single pump. Also, if prolactin levels are really a problem,
Reglan, and especially Domperidone, are both used to elevate the
prolactin level, I believe.

If I remember correctly, the half-life of prolactin is about 3 hours, so
even more frequent feeding/pumping causes will serve to keep the mean
level as high as possible in the early weeks while prolactin receptor
sites are being stimulated.

It might also be good to clue in both doc and mom that the milk making
tissue from the last pregnancy is now history- it was mostly involuted
after the end of the last lactation, sort of like the leaves fall each
autumn. A brand new placenta will have stimulated brand new alveoli, just
as each spring, a tree sprouts new leaves.

Gonnecke's suggestion of a thorough lactation management history and a
thorough exam of the breast by a lactation/knowledgeable person, is the
appropriate place to begin.

Then, well before the birth, teach mom (and MD) the basics of milk
production (that it's driven by thoroughness and frequency of milk
removal, and that the MER and a good latch will assure efficient milk
transfer) and make a lactation management plan modeled after the 10
steps.

Good luck. Let us know how it works out.

Jean
**************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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