I agree with Heather that the lack of early, frequent, continuing breast
emptying is the biggest factor in this case. I looked up the meds you
mentioned but couldn't find them, so I'm not sure what part they are
playing, other than it seems this mother had infertility history and some
hypoplasia of breasts, which certainly is another contributing factor. If I
remember correctly, the original post mentioned both babies were
tongue-tied, and that adds to the impact of ineffective breast drainage, as
well.
If this were my client, I would not worry about her prolactin levels, but
would institute a plan like Heather outlined for you. I agree with Heather
about the lactation aid (SNS or other), sometimes it works very well, and
sometimes it's just too "fiddly" for the mom, esp. with twins. I think
galactagogues would have a place here, and if you have access to the book by
West and Marasco, "Making More Milk" I believe is the title, that would be a
great resource.
Laurie Wheeler RN MN IBCLC
Mississippi USA

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