Hi Bonny & Anne-

Re: delayed lactogenesis- do you think prenatal hand expression might help?  After 38 weeks gestation?  And Anne - can you share which cultures you are noticing this delay with?



Mary Foley RN, IBCLC

Massachusetts







>

> Date:    Sat, 26 Aug 2017 13:57:16 -0400

> From:    Bonny Reid <[log in to unmask]>

> Subject: History of delayed lactogenesis

>

> Hi all,

> I am working with a mom who is expecting her 3rd baby.  She has had 

> healthy and uncomplicated pregnancies, births, and immediate 

> postpartum periods but has experienced a delay in increased production 

> volumes until day 10 with adequate supply and continued breastfeeding 

> beyond one year with both children.  We are discussing the use of 30mg 

> of domperidone or metoclopromide for a week or so beginning the day of 

> birth to try and expedite the onset of milk productioin. This would 

> possibly be in addition to alfalfa and moringa beginning at 36wks.  

> Likewise, maximizing hand expression and nursing within the first hour 

> of birth and prolonged skin to skin are at the top of the to-do list 

> of course.  I would love to hear thoughts or experiences regarding 

> similar situations and if this sounds like a reasonable plan.

> Many thanks in advance for sharing your wisdom and knowledge!

> Bonny Reid, MSW, IBCLC

> Raleigh, NC

>

>



             



Date:    Sun, 27 Aug 2017 16:07:00 +0000

From:    ANNE R EGLASH <[log in to unmask]>

Subject: history of delay in lactogenesis



Hi Bonny,

I would be interested to hear if she notices any difference with a medication that increases prolactin. Her own prolactin level should be at its highest during pregnancy and immediately postpartum. I would suspect that the delay in lactogenesis has to do with needing to unblock the prolactin receptors, which is what happens with loss of the placenta (drop in progest).

Obesity is a risk for delay in secretory activation, as is insulin resistance. Also, I have seen delayed secretory activation with SSRI antidepressants. In addition, I have seen this in some ethnic/racial cultures more than others.

Based on physiology, I am not convinced that domperidone or metoclopramide would help, unless she has a low prolactin level. I wonder if goats rue would be more helpful, because it may improve insulin resistance.

I agree with the maximization of nursing/skin to skin/hand expression in the first hour and first day to really jump start colostrum removal and nipple stim as much as possible.

Let us know how it goes!

Anne





Anne Eglash MD, IBCLC, FABM

Clinical Professor, Department of Family and Community Medicine University of Wisconsin School of Medicine and Public Health Medical Director, UW Lactation Services Medical Director, Mothers Milk Bank of the Western Great Lakes Founder and President of The Milk Mob, dedicated to building Breastfeeding Friendly Medical Systems and Communities













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