Jan wrote:
"At what point in the bf process (1 month, 3 months, 6
 months -- whatever) have you found that galactogogues are not effective --
 I'm talking about herbals (fenugreek, More Milk, Blessed or Milk Thistle,
 Reglan, Domperidone)?"

I am assuming you are speaking specifically of non-drugs, so are not referring to Regalan or Domperidone. I do not ever assume they cannot be effective, esp if the mom previousely did have a good supply.

" Second part to the question:  How long will you keep a mother on said
 galactogogues before you determine they are not working?"

So far, I have not seen at least some success with one treatment or another.

" Third part to the question:  What do you start with if you decide she needs
 an extra boost, and what do you go to?"

I never suggest only fenugreek. Maybe it is b/c I was suggestimg herbs long before funugreek became so popular and I am just used to others. I try to evaluate what the mother is willing to do. If she will use teas, I recommend a combination made by a local herbalist, which contains fenugreek, blessed thistle, fennel (I know there is disagreement about this one), hops (this is a bitter herb) and nettles. If she isn't likley to make and drink tea, I usually recommend More Milk or More Milk Plus, which she can get from the internet or purchase locally. I sometimes suggest only milk thistle (which is Dr. Lowdog's herb of choice). When I do, it is usually as a tea or tincture. I almost never suggest capsules.
    Also, if the mom is referred by a midwife or holistic practitioner, I often suggest Bach Flowers--certainly at least Rescue Remedy, possible cranial-sacral therapy and homeopathy (like lactusa virosa). If her doctor is a homeopath or naturopath, she may already be using galactogogues and I am fixing the mechanical stuff. I might also suggest goat's rue.
    I have had clients get definate improvement with herbs, but still need to take domperidone. Usually the herbs are enough in combination with correcting latch, etc. Unfortunately, I have also had clients unwilling to do anything except Reglan, and the results have been less than impressive.
Jennifer Tow, IBCLC, CT, USA

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