I think Valerie hit the nail on the head when she said that the original
problem with low milk supply may be the poor start breastfeeding got (i.e.
separation, not nursing right after birth, uncoordinated sucking from over
medicated mom, baby needing NICU, etc.) However, as we all know, these
things happen fairly frequently, and once the lack of stimulation has
created a problem in the early postpartum period, it is difficult to remedy
in some women with increased breast feeding and/or pumping alone.
As I understand it, normal lactation physiology requires that prolactin
levels rise for the first two weeks of lactation. Attaining a full and
stable milk supply is dependent upon that rise in the early postpartum
period. With inadequate stimulation, prolactin levels fall to prepregnant
levels rapidly, and we have found that many women have a chronic problem
with low milk supply following this scenario. Our best results with Reglan
have come in trying to remedy as quickly as possible, the early "low
prolactin syndrome" from inadequate stimulation and infrequent removal of
milk.
Once milk supply is established, an adequate supply can be maintained in
the face of prolactin levels which fall normally as time goes on, because
prolactin binding sites have increased in the breast. It requires a normal
supply of prolactin for the binding sites to develop and increase.
It seems to be the timing of the development of low milk supply which helps
determine what to do about it. I have found that Reglan does not work
particularly well after about 12 weeks post partum.
What I'd really like to see is Domperidone becoming available in the U.S.,
but it hasn't happened yet.
In the meantime, Reglan often works when all other measures have failed, but
as is usually true, prevention is the best solution.
Deanne RN, IBClC
NICU
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