I am working with a mom whose baby is 3 1/2 months old--I have permission to post. I did not see her until baby was almost 3 mos, as she had worked with another LC. This mom is a primip, over 40, who had difficulty with conception and delivered by cesarean after "failure to progress". She thought that the baby was nursing ok in hospital, but her milk did not come in until 10 days pp. When it did, she became severely engorged and got plugged ducts, but could pump almost no milk and baby wouold not gain w/o supplements. Later, her chiropractor had her start More Milk Plus, but the same thing happened--engorged, but unable to pump. I had her contact her midiwfe and she began domperidone 2 weeks ago (got in just under the FDA politically-motivated hammer). She is on 120 mg per day. Almost immediately her breasts felt fuller, but again, she was only able to express about 2 oz per day when pumping 6 times and putting baby to breast for almost every feeding. Baby has consistently needed at least 10oz of supplement per day to maintain good growth. Mom is taking MMP, Goat's rue and domperidone, but is also now using vitex.

My theory is that this mom actually needs oxytocin, that she may also be hypothyroid and that she may have a coritsol imabalance. I am guessing that the fertility history, "failure to progress" and engorgment with no MER indicate just that. I have been speaking to a compouding pharmacist about having a hormone saliva taes done, but we don't know excatly what to look for in a lactating woman. Baby also is seeing a CST, which has dramatically improved latch and suckle.

My question is this: Does anyone have any experience with the use of oxytocin in capsules vs the nasal spary? It appears the capsules have fewer side-effects, but may be much more expensive. If we use capsules, what is the dosage? Also, does anyone have experience with the use of oxytocin while still on domperidone? She needs to call her midwife tomorrow to to get a scrip--any dosage receommendation, esp for the caps?
Jennifer Tow, IBCLC, CT, USA