Hi Fiona!

I just read your post and hope to answer some of your questions the best I
can.

For starters, Diana West and Lisa Marasco's book "Making More Milk" is a
must for this mother, in my opinion.  It really breaks down every aspect of
milk production and can help this mother feel informed and ready to dialogue
with her healthcare team.

Next, you mentioned supplemental progesterone.  The only report I know about
this is:

Bodley, V., Powers, D. Patient with insufficient glandular tissue
experiences milk supply increase attributed to progesterone treatment for
luteal phase defect. Journal of Human Lactation 1999;15(4):339-43.

In this sample of one, the mother was given progesterone supplements in her
first trimester to help her sustain the pregnancy through her luteal phase
defect (when there is not enough progesterone to make the pregnancy
"stick").  The side effect was a full milk production when after her first
pregnancy, she had issues bring in her milk production.  This may or may not
be attributed to the progesterone supplement given during the first
trimester but it does make very good hormonal sense.

I have also heard (though I cannot cite this) of increasing progesterone at
the very end of pregnancy.  Since it is the precipitous drop in progesterone
(because of delivery of the placenta) that sparks lactogenesis, it stands to
reason that if the progesterone level is "high enough but could be higher,"
supplements might be of help.  I've not read a study or heard anecdotes to
prove this though it also makes good hormonal sense to my mind.

If this mother has PCOS and has been treated with metformin/glucophage,
maintaining this treatment during her pregnancy can be beneficial.

It bears mentioning that the milk-making herbs such as goat's rue and
fenugreek have an effect on blood sugar and should therefore be used with
caution (and a doctor's awareness) in mothers with existing blood sugar
issues.  Remember that as LLLL's and IBCLC's we are only in a position to
inform, not prescribe.  What you can do very well is encourage this mother
in what is normal newborn breastfeeding behavior and remind her that the
number one way to stimulate milk production is effective breastfeeding
management/milk removal.  Once that has been maximized, galactagogues can be
helpful.  Also see the Academy of Breastfeeding Medicine's updated protocol
on the use of galactagogues here:

http://www.bfmed.org/Media/Files/Protocols/Protocol%209%20-%20English%201st%20Rev.%20Jan%202011.pdf

I wrote an article on supporting mothers with mammary hypoplasia in La Leche
League's Leaven magazine a few years ago.  You can find it here:

http://www.llli.org/llleaderweb/lv/lviss2-3-2009p4.html

Feel free to encourage the mother you are working with to print this article
and bring it to her doctor.  She may also feel supported by this guest blog
post I wrote for Best for Babes, which is about my best friend, who is
breastfeeding her second baby with insufficient glandular tissue:

http://www.bestforbabes.org/2010/10/yes-you-can-breastfeed-successfully-no-matter-how-much-milk-you-make/

I hope this gives you a good start.  Thank you for hearing this mother and
for providing her with information and support.  So many mothers with IGT
struggle with feeling unsupported because there isn't tons of information on
this topic.  However, hopefully, as our community realizes this is an
emerging issue, there will be more research and discussion about how to
support these mothers and help them reach their breastfeeding goals.

--Diana Cassar-Uhl, IBCLC and LLLL in upstate NY

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome