Doreen, 
Regarding the mother whose supply is decreasing despite domperidone use. While anything is possible, I do not believe it is the medicine doing it. We do not use this drug in our area, so I am not familiar with the dose. Check to make sure she is on the maximum. While you did not give the whole case history for this dyad, I would think that the more usual factors are at play: primary lactation failure, possible retained placenta (if she has had other successful lactations), breast surgery, inefficient milk removal, premature baby, suck issues, delayed feeding at the beginning, etc. You also mentioned that she is switching between different size flanges, so that may be a factor that she does not have a pump to optimally extract the milk, so the type of pump and the type of flange may have to be further looked into. P.S. I am sorry for the formatting of my messages, even my computer savvy son cannot figure how to correct the ='s and such in my messages. If anyone can shed light on this, please advise. I can't find a setting to adjust html/text in hotmail.
Laurie Wheeler, IBCLC, MN, RN
Mississippi, s.e. USA

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