Ann, 
You mention that the mom is obese and has PCOS. Was metformin used to help
her conceive, and is she currently on it? She would be an excellent
candidate for metformin to help her milk supply if she tolerates it well.
Now would be an excellent time to lay the groundwork for this use if she
and/or her physicians are not aware of the possibility. 

I would also consider a low-carb diet (not no carb, not completely calorie
deprived), because this seems to help PCOS moms with weight loss, and when
they lose weight, their symptoms and endocrinopathy often improve. 

Don't rule out domperidone automatically. I think it's worth pitching to her
physicians with a thorough explanation of the politics and some background
info on wide international use. I would definitely avoid using
metoclopramide. I personally would consider using goat's rue as well, but
realize that this herb can also be controversial.

~Lisa Marasco

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