Re: Valerie's post about widespread use of reglan (metoclopramide) in US:

The only time I've ever seen it used successfully in my own practice has
been in a woman who was long-term pumping for a hospitalized very-early
preemie (like around a 28-wker or so). Baby was in hospital for about 12
weeks, in a town about 45 miles away; mom had good access to baby (i.e. she
could afford a functioning car & gas for daily visits), had been pumping
diligently w/medical grade pump, and producing enough for baby's needs.
About 4 wks before baby's anticipated DC, her supply began dropping, and
didn't come back up with the "usual" methods, including fenugreek; this was
happening at a time when baby was just learning to take the breast (and
doing really well for such a little peanut, I'll add!). She was
well-informed and determined, and it concerned her a great deal to be seeing
this drop in supply at a point where she was actually starting to need
*more*, and when it was so important for babe to have good success in his
early attempts. 10 days of Reglan did the trick for her, and when I went to
see her when the baby came home he was nursing beautifully and all was well.

I've seen this drop in pumped-milk supply happen frequently in women who are
faced with this kind of long-term pumping scenario (and I think we've
discussed it here on lactnet - check archives). I am not alarmed when this
happens, because we see it pretty often, but the mother may be quite
panicked, on top of getting quite worn out by the regimen of frequent
diligent pumping, which is not really very much like nursing a baby at all!
So, for these women, once the risks/benefits have been weighed, I think that
reglan (you're right - not long-term) may give that boost they & their
babies need.

And it won't help a woman with primary glandular insufficiency, am I right?
I think that it needs functional mammary tissue to work on - so there's no
use in giving it to a woman who has had no br. changes, no colostrum or milk
expressed, basically a breast that isn't going to produce milk because it
lacks the equipment for the job.

The other thing it isn't good for is a woman w/hx. of depression, or
currently depressed, or more likely-than-average to get depressed because of
other risk factors. Or one w/a sluggish, sleepy baby who doesn't like to
nurse yet, or can't stay awake long enough - it may worsen that problem.

Again, it's just a tool, useful & appropriate in some circumstances but no
magic bullet (don't we wish!)

Cathy Bargar RN IBCLC Ithaca NY

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