Janine

Happy New Year, what a challenging situation!

I'd agree with your protocol to induce lactation in this mother of 
twins with two modifications:

1)  Use manual expression rather than a pump to drain the breasts 
very well, if possible about 10 times in each 24 hours - that's 
whether or not they are taking supplements at the breast - it's the 
really good drainage of the breasts (regardless of breastfeeding 
itself, which may not be as efficient in 37 weekers)  which will 
stimulate the breasts to start -and continue escalating - milk production.
2)  Ask the doctor whether he would be prepared to prescribe 
sulpiride instead of domperidone for this mother.  As far as I'm 
aware, sulpiride is very commonly used as a galactogogue in southern 
Africa.  I've also found it to be extremely effective at a moderate 
dose (50 mg every 8 hours - more is not better!) and, most crucially, 
when the mother is ready, she needs to taper off this drug, 50 mg 
twice a day for a week, and 50 mg once a day for a week - or risk 
severe drop in prolactin levels and milk production.

Best to this mom and long-awaited babies

Pamela Morrison IBCLC
Rustington, England (formerly Zimbabwe)
------------------------------
Having just got back from a months leave my first case to deal with is a=20=

surrogacy situation where twin girls have been born at 37 weeks gestation=
.=20=20
Babies are doing well  and the new Mom has indicated that she wants to=20=

induce lactation to feed her two new babies. She was told by her GP to=20=

express her breasts twice a day about 3 weeks before the babies would be=20=

delivered, well of course they arrive a little earlier and this is when I=
  got called=20
in.  I have started her on pumping with a double pump 2 to 3 hourly, brea=
st=20
massaging and her doctor has prescribed domperidone and Fenugreek. She=20=

does not want to go on any hormone regime, due to her history of trying t=
o=20
fall pregnant.=20

I have looked at the archives and see that we are on the right course but=
  am=20
anxious to get the babies on the breast with a supplementer.=20=20

Please help, is there anything else I should be doing to assist this Mom?=
, she=20
is so excited after waiting 22 years for her babies.

I am finding it quite difficult to keep the Doctors and staff motivated r=
egarding=20
the inducing of lactation as they all feel it would be so much easier to =
bottle=20
feed and especially as it is twins.  She realises that she will probably =
not have=20
enough milk to feed both babies but is so anxious to try and breastfeed t=
hem .

Hope you can help.=20

Janine Johnson
RN RM IBCLC
George=20
South Africa.
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