Hello,
This is my first time to write to everyone, hope it gets through.  I joined
Lactnet last week and have enjoyed it so  much.

I am Ann Calandro, and I live in Waxhaw, N.C., south of Charlotte, almost into
South Carolina.  I am an RN, rrecently earned my RNC in Maternal Newborn
nursing, have been in LLL 18 years, and IBCLC since 1989.  I have 4
children-19,16,12, and 8.  I moved here from Atlanta last year, and there worked
as an LC  and also had a private practice.  Now I am working part time as an LC
and am starting up my private practice here in Union county, where it will be a
challenge, because the WIC director here tells me that there is a less  than 1%
breastfeeding rate in WIC, and the only hospital here does not have or feel they
need LC services.  I am going to call my practice Sweet Union Lactation
Services.  We will see what happens.

In Atlanta in our local ILCA affiliate group, we had a speaker at a conference
named Dr. Marilyn Washburn, who was very familiar with Reglan, because she had
taken it herself for her own decreasing milk supply,and was agreeable to discuss
it with other physicians.  The recommended dose was three times a day for a
week, then twice a day for a week, and then once a day for a week. After that
the mom would be evaluated to see if the dose was adequate, and sometimes would
take it longer.  We had very good results , seeing about a 50% increase in milk
in about 48 hours.  We did not have adverse effects except for some complaints
of being tired and more sleepy. Then I heard a speaker at ILCA in Arizona 2
years ago discussing how he sometimes kept moms on it for up to 4 months, but
beyond that time he began seeing women get depressed, aand would take them off
the medication. We tried all the usual things first, increasing nursing, pumping
double between to work at increasing milk.  The neonatologist in our NICU did
not hesitate to prescribe it to long term pumping moms who began to get a
decrease in output.  It was successful, but it needs to be put into relative
terms.  If a mom was getting one ounce per pumping and then got one and a half
ounces, it was an increase, but it did not mean she was all of a sudden going to
go back to getting 4 or 5 ounces each pumping.

One thing I have tried lately which seems to be helping some is to try and
simulate a real nursing baby in long term pumping moms, not just NICU moms, but
other moms who are pumping due to various other problems, who have babies at
home.  I ask them to sometimes do some "snack pumping".  That means that she
will walk by and pump a minute or two several times a day.  Real babies do this
frequently and putting some snacking into the schedule makes sense to me.  I
also ask them to schedule frequency days, every 7-10 days, where just like a
real baby, nothing gets done but feeding.  I ask them to choose a light day,
plan no outings and just relax and pump on and off, every couple of hours,
varying the times
so that her body can respond as if responding to a growth spurt in the baby.  In
that way I hope to avoid the decreasing supply as the baby's needs increase.

My sister is a psychiatric nurse with a private practice, and counsels women for
varying problems.  A couple of years ago she called me about a woman she had
been seeing for months who was anorexic and also OC-obsessive compulsive ( she
wanted to eat certain foods of certain colors at certain times and in a special
order).  She had been having this problem for years, and had recently gotten
pregnant.  She told my sister she planned to breastfeed, and had not changed her
eating patterns during the pregnancy.  My sister  felt she should not
breastfeed.  I told her to refer the woman to an LC at her hospital, and to have
her educated in normal breastfeeding management.  Then let her have a chance,
having, the baby monitored by the pediatrician.  After the baby was born, SGA
but healthy, breastfeeding was initiated.  I had not heard the ending so I
called my sister to ask how it went.  She said all went well, the mom was
thrilled and breastfed over a year.

Question-  Experience with women who are nursing newborns and go on the Weight
Watchers Lactation Diet.  I have had 3 moms who say they are eating more than
ever, but their milk supply drops while on this diet.  I am wondering if it is
due to the low fat intake?  Thoughts?

I am also planning to attend the ILCA conference this year, so I would like to
be on the list to get together with other Lactnet attendees.

Its good to have this network.  I am printing up lots of the answers to share
with my fellow LCs , and also our neonatologist, who has joined the physicians
network.

Ann M. Calandro, BSN,RNC, IBCLC