>I'm hoping I'm going to phrase this right to get the "right" answer....bear
>w/ me a minute here.  At what point in the bf process (1 month, 3 months, 6
>months -- whatever) have you found that galactogogues are not effective --
>I'm talking about herbals (fenugreek, More Milk, Blessed or Milk Thistle,
>Reglan, Domperidone)?

I frequently get calls from mothers of 3-4 months old infants. They had a
good supply until...something. I find that More Milk (blessed thistle,
nettle, fennel seed--and fenugreek if it is More Milk Plus) does help a
lot.  Usually they have been doing more pumping/feeding to work on the
supply, but it is just not doing it for them. The galactagogues do help in
most cases--of course along with continued draining the breast.

More Milk is quite efective in the newborn period also and there is usually
improvement within a day or two.

Many of my clients who use More Milk are working mothers who had good
supplies before beginning work. The MM helps increase their supplies and
some feel the need to continue taking it morning and evening to maintain
their supplies.

And I have had mothers of newborns for whom nothing increases the milk
supply. I have had a couple this past year for whom there is NO milk
production, not even drops of colostrum. Both of these women had serious
anemia/iron supplementing/constipation during their pregnancies. Even with
raising the hemoglobin levels and adding domperidone there was no milk
production. So sad.

>Second part to the question:  How long will you keep a mother on said
>galactogogues before you determine they are not working?

It depends on what has gone on before. If there was adequate milk and there
is a drop, then I encourage continued use for two weeks or more of the
herbals, checking for any improvement. I have had a few who noticed a
slight improvement within two weeks and who continue the herbs, going on to
greater supply--delayed reaction.

Usually there will be improvement within a few days, but some mothers are
so stressed out that it takes longer on the herbs (and longer on the phone)
to begin to see improvement.

If it is a case of low supply at the beginning and I suspect that there
isn't going to be much milk no matter what she does (having checked all of
the usual), I have her use the herbals for a week or two (along with
domperidone in come cases), see if there is any improvement, and if there
isn't she usually wants to stop the tinctures. Then I begin talking about a
supplementer and about the value of feeding at the breast.

Domperidone has worked for my clients in all but one case. Some of the
mothers were a few weeks post partum and some were a couple of months out.
They usually see improvement within 3-4 days.

>Third part to the question:  What do you start with if you decide she needs
>an extra boost, and what do you go to?

I begin with frequent feeding/pumping, then go to More Milk, look at diet
(for anti-galactogogues), then if she is eager, we begin negotiating with
her physician for domperidone. I never recommend Reglan because of its risk
for depression and anxiety. I have had a few who pursue the NZ or Mexican
connection for domperidone.

I'll conclude by saying that I never say never, after having one mother
have a "shrimpy" milk supply for 3 months, when one day she awoke engorged
and was able to stop all supplements.  This was without any herbs or drugs.
 I don't know all of what was at play here, but I suspect that some of the
problem was baby's poor suck. I recommended Cranial Sacral therapy for him
but the parents declined. Since that time I am more convincing (pushy) of
the need for this treatment.

Hmmmm. I haven't yet recommended CST for the mother who doesn't have much
milk. Maybe I'll try that sometime.  I did have one mother who had
acupuncture treatments with a good outcome.

Pat Gima, IBCLC
Milwaukee, Wisconsin
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