Dr Wade is my physician mentor at Kaiser Riverside and also active in the new
Acad of Breastfeeding Medicine. (Thanks for mentioning him Anne.) It seems
that those moms who have never been pregnant have little success at producing
more than drops of milk. It might be the lack of differentation and
proliferation of breast tissue that occurs with pregnancy as Dr. Wade
suggests or it may be related to the reason they are infertile. We have found
a slight increase in production if the mom uses a pump that massages the
areola in addition to the rhythmic suction. We tell moms to pump as if they
had a baby to feed--'round the clock.
We do not use medications to induce lactation. In fact, when we started the
Riverside clinic in 1989, we made a conscious decision not to use medications
for galactologues. We use brewer's yeast, occasionally fenugrek tea or other
nutritional supplements instead. I believe we have  good success without the
use of drugs.  I must admit that most of our success probably comes from the
*sales pitch* we give mom when we recommend supplements.
 I have serious questions relating to using Reglan (Metoclopramide) for
induced lactation or increasing supply.
This discussion is better suited to one of our pharmaciests but, here's what
I understand--- Theoretically, Metoclopramide doubles the milk supply by
increasing prolactin release from the pitutary. It is also a dopamine
antagonist, sensitizes tissues to acetycholine, and increases aldesterone
levels. ---  Double of nothing is still nothing. If mom has a 20cc supply is
the new total 40 cc worth the risk of the drug's potential side effects?
 Cardiac arrhythmias, extrapyramidal symptoms (1in 500), parkinsonian-like
symptoms, fluid retention, depression, anxiety, hypertension, to name a few.

There are positive studies related to milk increase with Metoclopramide but
 Lawrence (p570) also cites a study where there was no difference in milk
production in a double blind re-lactation study between sugar pills and
Metoclopramide.  Lawrence (p741) states 10-30% of newborn therapeutic dose in
mother's milk, the drug was found in the infant's plasma (1 case of 5 ) and
she also notes maternal Metoclopramide use may cause sedation and poor
feeding in the infant.

It seems oxymoronic to advocate something as pure as breastmilk and then
suggest potient drugs with potential serious side effects. Perhaps, the rush
to use medication is a side effect of our *magic pill* society.

Marie Davis RNCLC