Pam
Yes I have seen cases of low milk supply associated with infertility and
this is indeed a risk factor.
For this mother and her twins, could she use a supply line to give the
supplement?  This would allow more time at the breast and could help her
supply, and hopefully keep them from weaning early.
This might be difficult to manage with twins, so does she have help at home?
Does she have the twins on any sort of schedule, or do they nurse very
often? Nursing very often would be most helpful. Were they premies and did
she have a slow start to lactation and how big are they now and how much
"top up" formula do they take? Do they nurse at night? How often?
I know it would be hard, but could she also pump more frequently? Not sure
she could manage that - but even 5 minutes after each nursing session would
help. You might have to help her set up the pump with some extra kits maybe
so that she can readily do the pumping right after nursing.
Mom could stay on the herbs and actually take several like blessed thistle
or fennel with the fenugreek or goat's rue. Perhaps she can consult an
herbalist or the Motherlove herbal folks in Colorado (no financial
interest). She could also stay longer on the metoclopramide (Reglan), as
some moms have taken it long term, and make sure she tapers it off and not
stop it abruptly. I always have moms work with their primary providers when
taking herbs and/or prescriptions (of course) as I am not an expert there.
Laurie Wheeler, RN, MN, IBCLC
MISSISSIPPI USA

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