Karen

The low milk production you describe could well be due to PPH.  Sounds like
you have everything well in hand, with breastfeeding and
supplementing.  I'd want to know the Hb level, and might ask for a
progesterone level too to rule out retained placental fragments.  I have
worked with several women who appeared to have low breastmilk production
following PPH.  I find that if the mother is willing to go on stimulating
the breasts really well (breastfeeding plus pumping/expressing very
thoroughly and frequently, as you have suggested) that a full breastmilk
supply may be slowly stimulated by about six weeks postpartum.  It takes
great patience and persistence by the mother but she is eventually able to
reduce and then eliminate the formula supplements.  As to how *much* of a
PPH does it take to have a large impact on milk production?  I have to
confess I don't know, but this question interests me greatly too.  I've
worked with women who reported PPH and I've cautioned them that they
*might* experience it, need to monitor baby's output, weight gain etc, and
they've been *fine*.  Others are just not fine.  IME there seems to be no
consistency between the Hb level and the degree of lactation failure which
occurs so there must be *another* causative factor at work, unrelated to
the quantity of blood loss.

In Zimbabwe we use sulpiride as a very effective galactogogue, the usual
dose being 50 mg three times a day until the breastmilk supply has
increased sufficiently to cause the baby to gain adequate weight on
exclusive breastfeeding.  It takes about 4 days for the sulpiride to really
kick in, and this drug needs to eventually be tapered off to 50mg twice a
day for a week and then 50mg once a day for a week to avoid
depression/lactation failure from abrupt withdrawal.

Pamela Morrison IBCLC
Harare, Zimbabwe

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