Nikki,
Reading your thoughts on this has been interesting.  Reevaluating ones
methods and advice is always useful, although nothing in the debate so far
has made me anxious to change my ways.  I am curious because I don't
know--what kind of LC practice do you have?  Private or hospital-based?  Do
you see many mothers?  Not that I think you don't, I'm just trying to
envision how you would deal with low milk supply, for instance, in a busy
practice.

Now that I know about things like fenugreek, I have a hard time thinking how
I would go back to what I knew in the beginning, which was basically "nurse
or pump more often, eat and drink well, get more rest."  Personally, I'm
always looking for the "magic" that will help these mothers when we've done
the best we can with management.  I suggest fenugreek as an *option*
frequently, have given out for trial More Milk, bags of a tea mixture
suggested by a local direct-entry midwife, and am currently trialing Carol
Brussel's herbal tincture.  I always look up the ingredients of these
concoctions in several references first, and tell the moms what I know.
They're usually incredibly eager to try anything when they can't make enough
milk.

So what DO you tell a mother after you've tried all the management tricks,
and she still isn't producing enough milk?  Do you tell her about fenugreek
and blessed thistle and metoclopramide and suggest she talk to her doctor
about them?  Or just refer her back to her doctor?  I like the idea of a
certified herbalist and assume you must have one in Philadelphia, but I know
I don't and I'm betting most of us don't.  If I had to refer every mother
with low milk supply back to her doctor with a letter or phone call and
documentation on what might help, I'd never get home to my family and the
docs would be pitching fits that I'm bothering them with this stuff.  As it
is now, they send me things that are *clearly* not within my scope of
practice--if it's got to do with breasts they think I'll know.  So, please
share more specifics of what you would do in a situation like low milk supply.

Becky Krumwiede, RN, IBCLC
Appleton, Wisconsin
Old LLL Leader, hospital-based LC since 1991, 1250 births/year, 67%
breastfeeding rate, liberal out-patient follow-up

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