Hello, This is my first time to write to everyone, hope it gets through. I joined Lactnet last week and have enjoyed it so much. I am Ann Calandro, and I live in Waxhaw, N.C., south of Charlotte, almost into South Carolina. I am an RN, rrecently earned my RNC in Maternal Newborn nursing, have been in LLL 18 years, and IBCLC since 1989. I have 4 children-19,16,12, and 8. I moved here from Atlanta last year, and there worked as an LC and also had a private practice. Now I am working part time as an LC and am starting up my private practice here in Union county, where it will be a challenge, because the WIC director here tells me that there is a less than 1% breastfeeding rate in WIC, and the only hospital here does not have or feel they need LC services. I am going to call my practice Sweet Union Lactation Services. We will see what happens. In Atlanta in our local ILCA affiliate group, we had a speaker at a conference named Dr. Marilyn Washburn, who was very familiar with Reglan, because she had taken it herself for her own decreasing milk supply,and was agreeable to discuss it with other physicians. The recommended dose was three times a day for a week, then twice a day for a week, and then once a day for a week. After that the mom would be evaluated to see if the dose was adequate, and sometimes would take it longer. We had very good results , seeing about a 50% increase in milk in about 48 hours. We did not have adverse effects except for some complaints of being tired and more sleepy. Then I heard a speaker at ILCA in Arizona 2 years ago discussing how he sometimes kept moms on it for up to 4 months, but beyond that time he began seeing women get depressed, aand would take them off the medication. We tried all the usual things first, increasing nursing, pumping double between to work at increasing milk. The neonatologist in our NICU did not hesitate to prescribe it to long term pumping moms who began to get a decrease in output. It was successful, but it needs to be put into relative terms. If a mom was getting one ounce per pumping and then got one and a half ounces, it was an increase, but it did not mean she was all of a sudden going to go back to getting 4 or 5 ounces each pumping. One thing I have tried lately which seems to be helping some is to try and simulate a real nursing baby in long term pumping moms, not just NICU moms, but other moms who are pumping due to various other problems, who have babies at home. I ask them to sometimes do some "snack pumping". That means that she will walk by and pump a minute or two several times a day. Real babies do this frequently and putting some snacking into the schedule makes sense to me. I also ask them to schedule frequency days, every 7-10 days, where just like a real baby, nothing gets done but feeding. I ask them to choose a light day, plan no outings and just relax and pump on and off, every couple of hours, varying the times so that her body can respond as if responding to a growth spurt in the baby. In that way I hope to avoid the decreasing supply as the baby's needs increase. My sister is a psychiatric nurse with a private practice, and counsels women for varying problems. A couple of years ago she called me about a woman she had been seeing for months who was anorexic and also OC-obsessive compulsive ( she wanted to eat certain foods of certain colors at certain times and in a special order). She had been having this problem for years, and had recently gotten pregnant. She told my sister she planned to breastfeed, and had not changed her eating patterns during the pregnancy. My sister felt she should not breastfeed. I told her to refer the woman to an LC at her hospital, and to have her educated in normal breastfeeding management. Then let her have a chance, having, the baby monitored by the pediatrician. After the baby was born, SGA but healthy, breastfeeding was initiated. I had not heard the ending so I called my sister to ask how it went. She said all went well, the mom was thrilled and breastfed over a year. Question- Experience with women who are nursing newborns and go on the Weight Watchers Lactation Diet. I have had 3 moms who say they are eating more than ever, but their milk supply drops while on this diet. I am wondering if it is due to the low fat intake? Thoughts? I am also planning to attend the ILCA conference this year, so I would like to be on the list to get together with other Lactnet attendees. Its good to have this network. I am printing up lots of the answers to share with my fellow LCs , and also our neonatologist, who has joined the physicians network. Ann M. Calandro, BSN,RNC, IBCLC