Talking of the ethics of accepting donor milk from a mother who is
expressing in excess reminded me of a current donor.   She was initially
donating over 4 litres a week as well as feeding her premature baby
successfully, and she would sometimes contact me a day or two early so that
I could bring her more jars as she had filled up what she had and was
getting up at night to express down the sink for comfort.   (This was all
hand expression).  With her first child, she had borrowed two toddlers in
the family to help relieve the excess!

I wondered if she should be tested for pituitary issues, and I have to
admit... I was reluctant to suggest it too early because the milk bank
certainly needed the milk.  Bad, bad me.   I am not sure at which stage
milk production is "really too much" and indicates hyperprolactinemia.  But
while I was dithering, I noticed that her supply to us was decreasing
steadily, and last week she only managed to 700 mls, and she said she will
give us the last batch next week.   So she has self-managed this problem in
about 10 weeks.

I followed up the baby closely all along, to make sure the growth was good
and that she was able to cope with what I presumed was a strong flow, and
she is doing well so far.

Interestingly, this mother is on Metformin, and I heard Diana West's recent
conference session on making more milk where this drug had been shown to be
a potential way to increase supply.  Not that one will be encouraging
mothers to take the drug without the medical need for it.

Best wishes
Jacquie Nutt IBCLC

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