I am hoping for some wisdom here as i am out of ideas, I have permission to post.

G2P2, with hx of DVT in 1st pregnancy which was treated with lovenox, then heparin from 36 weeks until delivery, then lovenox until 6 weeks pp.  Birth fast but otherwise uneventful and postpartum period interesting in that mature milk was not "fully in" until 8 days pp, but at that point she had a booming supply and nursed until 2+ years, into her second pregnancy.

On lovenox (lower prophylactic dose) the entire second pregnancy, and the protocols have changed at the local teaching hospital so she was not transitioned to heparin and then back to lovenox but kept on lovenox the entire time.  Again a fast but uneventful birth, at term (like the first). We were prepared for the possibility of delayed lactogenesis 2 because of her first experience so she began stimulation after breastfeeds right away and had donated EBM available if needed.  Breasts got heavier by day 5 but needed to supplement large amounts in order to keep baby gaining weight.  No change in production by 2 weeks (pumping with hospital grade pump after q feed) drew prolactin and HCG.  Hcg normal (placenta had been delivered easily and intact and lochia was normal pp) but a prolactin of 12....we thought Aha this is the probem, got her on domperidone 10mg tid then 20mg tid with no change in production, rechecked prolactin 2 weeks into domperidone use and it was essentially unchanged at 13.  She went off the domperidone (thinking maybe it was a "bad batch" got another supply in the mail a few days ago and began again) and is now convinced it is the lovenox and that when she goes off it at 6 weeks that things will improve.  She is supplementing 16oz donated EBM per day and is now 4.5 weeks pp.

any ideas any of you have would be greatly appreciated.

we have stayed away from most herbal galactagogues because lovenox has so many contraindicated medications and there is so little information about many of the herbs.

Thanks and I hope everyone has a lovely holiday and has a happy new year.
Ami Burnham LM, RN, IBCLC

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