Dear Jennifer,

Again, basing my reply partially on the anecdotal experience of my daughter 
who continues to pump for her 12 1/2 mos old, I'll add a couple of thoughts to 
others' responses.  Could she exchange her Lactina for a Classic which might 
tweak supply a bit?  As someone stated about frequency, could she manage, for a 
short while perhaps, to pump for 5-10 min during the night to take advantage 
of increased prolactin levels?  Once she increases pumping a bit, more 
frequent pumping sessions here and there of 5 or so min, or power pumping once a day 
for a few days (pump for 10 min every 45 min-1 hr for a 3-4 hr interval), she 
could increase her domperidone to 120 mg/day; 20,20,30,40 mg.  

She might try Rescue Remedy to improve MER before pumping; pump for 5 min, 
stop, massage breasts, stimulate nipple with gentle rolls, wait 2-3 min, then 
pump again.  (I suggested this last night to my dd who had been pumping for at 
least 5 min with only occasional drips by then and she double her output.) 
Suggesting the usual ways to increase supply, like good hydration and diet, having 
a bowl of oatmeal daily, etc may help.  Herbal galactagogues may be helpful, 
but like an increase in domperidone won't help much without an increase in 
milk removal.

Lots of TLC and pats on the back to this mom for all her hard work can help, 
which might come from family and friends, other than just you.  I've sometimes 
offered to let moms call me when they're pumping when supply is low, and even 
rather than give a pep talk, just talk about other things, laugh together, 
etc and at least that pumping time tends to yield more, and mom sees it can 
happen.  I've had moms cover their flanges and breasts with a warm, moist towel 
while pumping, which serves two purposes: one, "a watched pot doesn't boil," and 
the heat is relaxing, encouraging letdown.

I second the idea of donor milk being used for skimming fat, but hopefully, 
mom can begin to increase supply and be able to use her own.  Hope any of these 
tips are helpful.

Barbara Latterner, BSN, RN, IBCLC


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