In response to Nicolas post:

I am unable to comment on lactina vs symphony as the latter is not available for hire in my area, so it is lactina or nothing.

I have however, had several women with a similiar scenario to yours recently.  It sounds like you are on the right track with the management. I would just add in double pumping, some cluster pumping (over several hours in one part of the day), and breast compressions towards the end of the pumping session.  This will require changing from double pumping to single pumping at the end.

Also, what dose of domperidone is she on?  Check Jack Newman's site for maximum dose for a short period of time.

My most recent example was a women with a 25 week baby.  At 2 weeks postpartum (when I first met her) she was pumping no more than 200 mls per day. Her breasts did not look like lactating breasts. I suspect she had an underlying medical problem due to her obstetric history as well as some of the signs of PCOS.  With a pumping regime (much like yours) and keeping a log this woman managed to increase her supply steadily by about 50 - 80 mls per week!  It was hard going there for a while.  Anyway, she finally got to the magic mark of 550- 600 mls per day and she has maintained nicely there for some time now.  Feeding has recently started and she will keep pumping until the baby is a lot bigger and stronger.

Breast compressions was probably one of the most useful tools she used.  She started to have several letdowns per pumping which made all the difference.

I never cease to be amazed at the committment many women have towards their tiny babies.  This particular baby has some ongoing lung problems so thank goodness she is going to be breastfed.

Karen Palmer
IBCLC 
Hamilton, NZ



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