This is a very interesting situation.  Thinking about it, I realize that I don't know much about what the mechanism is by which domperidone increases prolactin levels.  If it does so by stimulating the pituitary, I guess it wouldn't be helpful in a mom with no pituitary, but I wouldn't think it would hurt to try it and see what happens.  The fact that she is at least able to pump drops is very encouraging, though.  

I think this sounds like a very good situation for a long-term plan with the Lact-Aid.  Get the baby suckling well and have mom just get into a routine of all feeding/nurturing at the breast, with the Lact-Aid as needed.  Since the situation is so unpredictable, and the prospects for a large milk supply don't sound too good, I think having her establish a routine is especially important.  With that in place, you not only have the emotional benefits taken care of, but have a situation where whatever potential for milk production there is will be realized, without her having to do anything else.   She can do other things to try to produce more milk too, but success (a happy, healthy baby and a happy, confident mother) is much more likely with feeding and nurturing at the breast as a foundation.

I strongly recommend the Lact-Aid, over the SNS, because it promotes more efficient suckling but, especially, because it is so much more practical for using many times a day, over the long-term.  It is especially helpful if the mom can get enough units that the cleaning and filling can be done no more than twice a day.  Lact-Aid has a packaged deal where someone can get four units for one lower price, rather than having to buy multiple kits.  With a double kit and then four more units, cleaning and filling can be done alternating once one day and twice the next, until the baby starts on solids and then usually once a day is the most that is needed from then on.  The initial investment is a fair amount, but Lact-Aids are very durable, and having the baby get even a small amount of breast milk a day will make up for it quickly, in savings on formulas and probably antibiotics and doctor visits.  

This is just a guess, but I would think that what would happen here is that milk production will increase, but stay at a fairly low level.  This mom and baby can have tremendous benefits, though, just as in adoptive situations where milk supply is limited.  Since this mom is coming from a situation where she was not even expected to be able to give birth to a baby, I think she is likely to be able to appreciate the opportunity for nurturing and providing immunities through a smaller amount of breast milk, than someone who expected a normal course of events all the way through, and then had trouble providing much breast milk.  I think the way she is counseled is important, though.  Too much concentration on milk production alone can be counterproductive.  Any mother who can learn to love the experience of her baby at her breast is likely to keep doing it, giving her baby the benefit of whatever milk is there, and giving both her baby and herself the nurturing benefits, for a long time, hopefully, until child-led weaning occurs.

As far as giving synthetic prolactin, none has been developed for human use.  I, and other adoptive moms, have thought about trying the bovine preparations that the dairy industry uses, but I don't know of anyone who has actually done so.  Except for, possibly, if there was a situation where the baby just couldn't get by being supplemented with formula, I wouldn't try it.  

One more thing for this mom.  I would really encourage her to get online with either the Adoptive Breastfeeding Resource Website ( www.fourfriends.com/abrw) or the forum that JP Bonner leads, which she posted the URL for a while ago.  Contact with other moms who are breastfeeding under special circumstances would be very helpful.  

Aloha,
Darillyn Starr
Adoptive mom of six

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