Saw a mother about one week out, with a low milk supply -- baby 
transferred about .5 oz., with lots of compression and stimulation , and 
the motivated mother gets less than that when she pumps intermittently  
It was a big baby, c-section, following some issues with gestational 
diabetes, also difficulty in conceiving, and the milk was late to 
arrive..  Mother has not been diagnosed with PCOS -- never heard of it 
--, though shows several symptoms, including the aforementioned blood 
sugar issues, some body-hair, wide-spaced breasts with underdeveloped 
lower half (though a fairly round and firm upper half -- if she hadn't 
removed her bra, it would have been hard to see.)  As a first line of 
attack, we got a better latch, with compressions, herbal galactogogues, 
and starting more regular pumping.  I've discussed prescription 
medications as a next step, and suggested a screening to rule out 
thyroid issues, anemia or any current blood sugar issues.

I'd like to provide her with some good references to discuss the 
possible PCOS diagnosis with her doctor, and would like to hear 
suggestions on the most effective literature to share.  How open have 
you found doctors to prescribing metformin?  Would it have to be in 
response to tests revealing certain blood sugar levels or some other 
specific marker, or would they be willing to prescribe on the chance 
that it might help the milk supply?

If that diagnosis was confirmed, would metformin be more likely to help 
than Reglan/Domperidone?  Would a person take them both together? Should 
fenugreek be discontinued, since it also has some potential for lowering 
blood sugar?  Are there risks to taking metformin -- some of the Web 
drug info on side effects is scary, but it's always hard to put that in 
perspective.  How hard should she press to get someone to 
diagnose/rule-out PCOS, since it seems to be a rather loosely defined 
set of symptoms, with very variable effects on lactation.  Or is that a 
next-stage, to pursue if galactogogues and ongoing milk-removal don't 
help?  It's always a question how far and fast to move while waiting to 
see the response to each strategy.

I've read back over some of Lisa Marasco's great posts on this topic 
(I'm really looking forward to the book that she and Diana West are 
writing on milk production) but since her work is really at the leading 
edge, it's sometimes know how to proceed in these ambiguous real-life cases.

Margaret Wills, LLLL, IBCLC

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