Dear Esther,
You said.. "Tried Fenugreek & Blessed Thistle tinctures
for 3-4 weeks w/out improvement, for the last week has tried Domperidone
20 mg 3-4x/day, but supply has continued to decrease."
Try Domperidone on this schedule: 20, 20, 30, 40mg and have her take it 20-30
min before pumping/breastfeed during the day as drug levels peak at about 30
min; make sure she pumps once during the night. I'd suggest she use Classic
or Ameda's Lact-e or SMB (rental) as in my experience Lactina often isn't as
effective for moms with supply issues.
"Mom has never pumped more than about 75 cc total from both breasts, "
when was this? and when did supply decrease after this? 75 cc is not a bad
total and could easily sustain a baby who could nurse more frequently to
provide adequate intake.
"now is getting usually 10-30cc." This is, no doubt discouraging for mom,
but may be due to ineffective pumping; would also try different size flanges
as sometimes I've found that even if mom seems to "fit" flage she's using a
larger/softer flange stimulates and compresses milk sinuses better.
Skin-to-skin as much as possible, offering breast for comfort, hiccups, any little peep
might help to raise prolactin levels as well as help baby realize these
breasts are pretty special.
"Baby has variety of issues in terms of suck pattern, poor latch, trouble
staying awake at breast, etc."
How have these suck issues been addressed? Why poor latch? breast shape?
mom or baby's oral/motor difficulty? Addressing these issues and improving
suck would increase milk yield.
"and has recently begun using SNS, which helps but baby still only transfers
about 35ml from the SNS and I am not sure she is getting much of any transfer
from breast . "
Are you able to do test weights? How is SNS being used? Open throughout
feed? sometimes opening at start to get this baby some calories and energy, then
clamping for a bit so baby is getting milk directly from breast, then opening
again when baby slows down/tires might yield more from direct breastfeed.
"possibly adding Goat's Rue, or using the Mother's Milk Plus. "
Definitely concur with this plan; using goat's rue tincture in addition to
MM+ (or similar brand) rather than the combination of these is suggested. Also
Mechell Turner's site (birthandbreastfeeding.com) has a letdown homeopathic
tincture that might help. (I've no commericial interest in these or any products
mentioned)
"Also wondering what you all think of her chances at this point, 6 weeks
postpartum, of getting even a better partial supply??? This mom has been working
SOO hard...."
I never say never to moms and with improvement in baby's sucking, tweaking of
what's being done, and lots of encouragement and support, supply could
definitely come up. Domperidone can take at least 2-4 wks before effect is noticed
and may definitely work better with goat's rue. She may need to stay on both
of these for duration of lactation.
Hugs to her for working so hard, it's never easy, but so worth the
efforts. (and to you, too for helping her stay afloat; it's hard to feel helpless
when we LC's seem to run out of solutions, but from my experience, moms who
feel supported and cared for, regardless of outcome, continue to try and
appreciate the support).
I've had moms read about adoptive nursing situations, Diana West's
BFAR book because the situation is similar and helping mom to come to see the
importance of the relationship part of breastfeeding and not just the milk yield
can help her to enjoy it. I've found when the problem parts of breastfeeding
are focused on too much, it is way too draining on everyone; telling her how
wonderful it is that her baby has the comfort of her breast, etc and how
important that is...
Sorry for the length but since I'm going thru this type of situation with my
daughter and now another new mom, all these (and probably more I'm not
thinking of now) tips are always on my mind.
Barbara Latterner, BSN, RN, IBCLC
Brewster, NY
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