We are having an epidemic of new mothers of sick babies who are doing
everything right and are producing NO milk.  It's so eerie. This mom is
even in the same bedslot in the NICU as the last mom who didn't produce
any milk.

What is unusual about this mom is that she was on Reglan for
hyperemesis her entire pregnancy and also for 48 hours after birth.  She
was gestational diabetic treated with diet for two weeks and then insulin
for 3 days.  She delivered at 32 weeks and was on magnesium sulfate
for 2 days.

Mom began pumping with a hospital grade pump the day after delivery.
She never felt any engorgement at all and never was able to pump more
than drops.  Her baby is now 11 days old.

I have reviewed Ruth Lawrence's discussion on hormonal control of
lactogenesis and mammary development during pregnancy and it seems
to me that Reglan prenatally would have had the same effect as
postnatally - to decrease prolactin inhibiting factor (PIF) thereby
increasing prolactin.  My question is:  Would stopping the Reglan at 48
hours increase PIF and cause prolactin to fall resulting in lack of any milk
production?  Should mom go back on Reglan?  (Why are hormones so
complicated??)

TIA.   Rachelle Lessen, RD, IBCLC