She can't be completely panhypopit, since she got pregnant.  There is more
to breastfeeding than breastmilk.

Here is the way I proceed for "insufficient milk supply" (actually, most
mothers have lots, but the problem is that the baby is not getting the
milk
which is available).

1. Get the best latch possible.  This needs to be shown by someone who
*knows* what they are doing. *Anyone* can look at the baby at the breast
and
say the latch is good. The accompanying diagram, or the one available at
the second website below shows how to get a good latch.

2. Know how to know the baby is getting milk (open-->pause-->close type
of
sucking). See handout: How to know my baby is getting enough milk at the
websites below.

3. Once the baby is no longer drinking, use compression to increase flow
to
the baby.  See handout Breast Compression at the websites below.

4. When the baby no longer drinks with compression, switch sides and
repeat.
And keep going back and forth until the baby does not drink even with
compression.

5. It is not always easy to decide if a baby needs supplementation.
Sometimes more rapid growth is necessary. If possible get banked
breastmilk to supplement if you can. If not formula may be necessary.
However, sometimes slow but steady growth is acceptable. The main reason
to worry about growth is that good growth is one sign of good health. A
baby who grows well is usually in good health, but this is not
necessarily so. Neither is a baby who grows slowly in poor health, but
physicians worry about a baby who is growing more slowly than average.

6. If it is decided to supplement, the best way is at the breast with a
lactation aid. Introduce the supplement with a nursing supplementer
(lactation aid), not bottle, syringe, cup or finger feeding.  See
handout on Lactation Aid at the websites below. Supplement only after
steps 3 and 4 above and the baby has nursed on at least both sides.

7. If the baby is over 3 or 4 months of age, adding solid foods is probably
a better strategy than adding formula. See the handout on Solid Foods at the
websites below.

8. Domperidone is a possibility.  It is not a panacea.  Check the
handout on Domperidone at the websites below.  You can get it COD from
Mexico at the following number.

011 526 654-1834

Oscar and Gabriel speak English.  They send it C.O.D. As far as I know
they have been very reliable.

Or, a Canadian Pharmacy will send you domperidone if you get a prescription
from your doctor. Phone for more information: murray shore pharmacy
800-201-8590.

http://www.erols.com/cindyrn/drjack0.htm

or

http://bflrc.com/newman/articles.htm

or

http://www.firstfeast.com/articles/articles.html

Jack Newman, MD, FRCPC

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