Bromocriptine is not actually contraindicated during breastfeeding because
of its effect on the baby, but rather because of its effect on the milk
supply.  If the mother can maintain a decent milk supply on bromocriptine,
then there is no reason why she should not breastfeed.  The question in the
first mother is why does she need bromocriptin?  I may be wrong about this,
but I do not believe that bromocriptine slows the rate of tumour growth,
just decreases the prolactin secretion of the tumour.  What's wrong with
having prolactin secretion?  Well, it may prevent you from becoming
pregnant, or may result in spontaneous milk production when there is no
baby.  So, when the mother does want to breastfeed, does she need to be on
the bromocriptine or any medication at all?  That's the real question I
would say.

There is one more thing.  There have been some mothers who had been on
bromocriptine who, when off it, did not seem to produce enough milk.
Strange, but I wonder if there is not a long term effect?

If the baby did not gain even one ounce, he was still getting breastmilk.
We generally say that about 30-40% of the baby's calories are for growth, or
put another way, a baby who maintains his weight but does not gain, is
probably getting in the region of 60-70% of all his required calories.  It
would be a pity to stop breastfeeding when the baby is getting that much.
If the baby needs supplementation, well, it's better he gets some breastmilk
than none.  A lactation aid or nursing supplementer would allow the baby to
be supplemented while the mother continues breastfeeding, as long as she
wishes.

For mother #2 (and #1 for that matter).  Get the baby latched on as best
possible.  Teach the mother how to know the baby is getting milk. Use breast
compression. Switch when the baby no longer nurses, and repeat.  And if the
baby is not getting adequate amounts of milk, then the baby may need
supplementation, again with a lactation aid, not a bottle.  See the
breastfeeding decision tree in the JHL in June 1996.  For mother #2 she
could use blessed thistle and fenugreek as well, and maybe alfalfa too.

Jack Newman, MD, FRCPC