Hi Hilary,
I'll place my comments through the text.

Kudos to whomever mentioned to this mother that relactation was possible, if
no one had mentioned she wouldn't know. It's always worth telling a mother
about breastfeeding. She's lucky tthat she has you to help her too.

 About a
> month ago she came to the support group because she was still leaking and
> wanted to know how to dry up. Someone suggested that she could start
> breastfeeding again and she was absolutely thrilled.

When it comes to relactation I think that it is worth going in strong from
the beginning because otherwise it can get very discouraging. How much
Domperidone was she taking? I'd suggest that 80-90mg/day is what you'd want
and that one week is nowhere near long enough to see whether it would have
an impact. Every mother I have heard of who has used Domperidone to assist
in relactation/induced lactation has found it helpful. I would suggest that
it is worth having another go for at least a month.


> First I just suggested she could let her daughter go to the breast for
> comfort but she decided that wasn't enough and wanted to fully relactate.
So
> I lent her a pump and told her about domperidone, which she took for a
week
> with no appreciable change.

Is it a double pump? Using a pump to assist in relactation has a dual role,
firstly to increase prolactin levels which induce changes in the breast
(like those that occur during pregnancy) and secondly to remove milk.
Studies have shown that pumping both breasts at the same time results in a
greater increase in prolactin levels than serial pumping. Has she got a
setup so she can pump hands free? I'd also suggest that she might want to
pump for 20 mins at a go (there is no research on this but this is my gut
feeling based on my personal experience and from listening to mothers).
That said, that her baby is willing to breastfeed is wonderful. In my
opinion it is a much better use of time to have the baby at the breast than
to be pumping and  supplementing so anything she can do to maximise suckling
is beneficial. Does she cosleep? Lots of mums find that when their baby
starts breastfeeding during the night it results in a big increase in supply
(remember apart from increasing freq of breast emptying prolactin secretion
is enhanced at night). Does she use a sling? (studies have shown that babies
kept close to their mum breastfeed more frequently). You might find it
helpful to get a hold of a paper I wrote on adoptive breastfeeding in the
March (?) issue of Breastfeeding Review which discusses what we can learn
for mothers in developing countries (who are shown to be more successful in
terms of milk production than women in the West) and how to maximise milk
production.
This mum may also be comforted to know that eventually her baby's need for
milk and her ability to produce it will match up (his intake is decreasing).
I also wonder how she is guaging her production (knowing that pumping is
often not a good indicator of supply).
Excellent point that breastfeeding is about more than milk...in fact that's
only 1/3 of the picture the other 2/3 are comfort and closeness and
breastfeeding has a big impact on her child's emotional health and also
assists her to be the best mother she can be.

Good luck!
Karleen Gribble
Australia


Also gave her some tubing to mock up a
> supplemental system. For the last 2 weeks she has been pumping at least 6x
> daily four 10 mins/side and breastfeeding whenever she can using the
tubing
> with EBM or formula. She is taking fennel tea. She still  gets only about
> 20-30mls from pumping. She feels really disappointed and wonders if she
will
> ever be able to produce a better supply. I have tried to be positive and
> point out that bfing isn't just about getting food etc.

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