lisa, about your mom with the lowered supply - i think that if the supply
problem has developed over a longer period of time (weeks and months rather
than just a few days or a week with an established supply), i treat it more
aggressively. that is, i recommend tincture and domperidone right away, not a
slow progression "up" to domperidone. this also reflects my impression that
reglan is unsatisfactory to many mothers, and doesn't work as well as
domperidone. these can be done while the question of hormonal imbalances is
addressed.

i recently had a patient who reported a long history of high estrogen. she
produced virtually no milk whatsoever at two weeks after the birth (10 ml.
from one breast, 0 from the other, which had had two previous biopsies). when
tested at about three weeks out, her estrogen levels were extremely high,
looked like the end of pregnancy. prolactin was marginal but probably okay.
she saw an endocrinologist who did test again at six weeks - all levels were
normal. despite the typical interventions, including the domperidone, she has
not produced much more milk than after the birth, although she was not as
diligent about doing "everything" as we might hope.

carol brussel IBCLC

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