I prefer stimulation, herbs, and domperidone over hormones.  I have had 
good outcomes with the three of my preference.

The herbs that I recommend are More Milk Plus and Goat's Rue (from 
Motherlove company) and domperidone. Pumping is begun at 5 minutes 3 times 
a day, increasing to longer pumping and increased frequency as the mother's 
nipples get used to it.

Given this mother's history I suspect that her milk supply will increase 
quickly when the baby is at the breast. Once the baby is here I recommend 
lots of skin to skin for milk supply increase and for bonding.

One thing that I learned recently that has helped my clients who are using 
More Milk Plus (fenugreek, blessed thistle, nettle, and fennel seed) is 
that when the supply reaches a plateau the mother takes a break of 3-4 days 
off the herbs and then resumes.  There is another jump in supply. She can 
do this any number of times.

Gillian, you can write to me if you want more detail on my protocol.

Patricia Gima, IBCLC
Milwaukee, Wisconsin

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