Hi to all
It has been a while since I last posted and I think it was on the
Newman-Goldfarb protocol, so after reading all the posts related to it
recently I thought it might be a good idea that I respond.  We have just
opened a breastfeeding clinic at the Jewish general hospital here in
Montreal and as of today a no fee service is offered, of course mums can
give a donation if they want.  We are a group of 1 IBCLC (me) 1 hopeful
IBCLC, 1 family med doctor and 2 Family med residents who are learning
to assess and assist breastfeeding mums.  We are presently open 2 - 3
days a week, started with 6 clients the 1st week and now see between 20
- 30 clients a week.  We have yet to do any official advertising to the
doctors or local public health clinics, this is mainly word of mouth
referrals. We also have a Family Med doctor from the UAE who has been
training at Dr Newman and our clinic during this past year as she wants
to open a breastfeeding clinic when she returns to UAE this November.  I
think there is a Lactnet member from UAE, if you are interested in
contacting this doctor she would love any support, please contact me
personally.  Next, a comment on the N-G protocols.  We work with
modified versions of this protocol often.  Generally we will use
domperidone alone with pumping and or a lactation device with mums who
give birth to there babies and are relactating after short periods (< 2
- 3 months) as well as with mums who have had breast reductions or mums
who have low milk supply even after trying extra pumping, herbs, baby
honeymoons and everything anyone has suggested.  In general there is
very good responses with the majority of mums. We generally start mums
on 10mgs 4 times a day for 5 days then increase to 20 mgs 4 times a day,
if there is a milk plateau, then this can be increased to 30mgs 3 times
a day, which seems to do the trick.  The reason for the slow increase is
to observe for any side effects (diarrhea, skin rash, headache).
Karleen is correct in questioning giving Domperidone related to meals.
We want the best absorption of domperidone to have the best effect of
increasing prolactin so in a way yes it is better for the mum to take it
before meals.  I was and am happily surprised to find most mums were
happy to take domperidone if it was going to decrease the amount of ABM
they had to give the baby.  We explain that both are drugs, one goes
directly to baby without filtration (ABM) and the other (meds) through
mum who has a very good filtering system (breast).  We do have a mum at
present on the full protocol and has been on it for 60 days with
wonderful breast changes (fullness) and will be starting to pump next
week as her babies are due soon.  She can manually express clear drops
of fluid from the breasts which made her feel great.  Before she started
the protocol we did blood prolactins, oestrogens and progestrones and
have repeated them monthly, the mum wants to do this.  She has had some
spotting while on the Diane 35 around the times her period would
generally have been.  She also told us that this has happened to her
even when not on the pill when ever she is more stressed.  Interesting!
I will be happy to let you know how thing work when the babies arrive.
I was lucky enough to follow another mum who's surrogate happen to give
birth the day before to her twins at 28 weeks.  I went to see her in the
hospital the day after the babies were born and she had stopped the
Diane 35 the day before.  She had only been on the protocol for 42 days.
At that visit she was able to express 5 mls and that day pumped Q 2 - 3
hrs and pumped between 3 - 10 mls per pumping.  The babies were only
taking 2 mls per feeding.  Within 10 days she was pumping 20ozs in 24
hours.  The babies are several months now and the babies are getting
only one 4oz supplement of ABM a day.  Had she had a singleton she would
have had an abundance of milk.  There are different ways of helping
mothers with milk production.  The best thing is to inform her of all
the choices available to her, the risks and benefits and discuss the
expectations that she has not what we have.  All mothers need support
and correct information and the knowledge that not all women are the
same, what works for one may not work for another.  The N-G protocol is
not for everyone but if it can help some mothers then I have no worries
about explaining this protocol to them.  This is probably a great
suggestion for lactation research.  Now I have to go and wash my 4 boys
and there dad's hockey equipment - smelly.  I don't think I would be
doing this if I was living back home in sunny south east Queensland
where it is hot and humid.
Carole Dobrich RN, IBCLC,
Aussie living in Montreal, Canada



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