These are not tips for those of you trying to establish milk supply, unless we've talked about it first. I'm putting this info up for moms trying to increase the amount they pump at work, or other scenarios where the supply had been OK and has been dwindling.
Before we use these medications/supplements, we have to make sure the latch is OK, we're using breast compression, we've tried pumping after feedings to increase breast stimulation, and that there isn't some other reason the supply has dwindled, like increase stress (hah!), poor diet, lack of sleep (double HAH!) starting on an estrogen containing birth control pill, thyroid problems, pregnancy, oversupply, pseudoephedrine cold medications (or any other medication for that matter.) Actually, one of the bigger reasons to have your supply drop off is pregnancy. That's an easy test to check and a good place to start.
Usually, the supply is lower because you are sleeping longer at night and not getting as much stimulation at the breast or you're back at work and can't pump as much as you'd like. Fix that first. A first sign that you aren't getting as much breast stimulation is getting your period back...frequent breast stimulation keeps the period away, but as soon as you consistently go longer than maybe 4 hours or so without feeding/pumping, your period may come back.
Plus, you make a bunch more milk than you need in the early weeks, and then the baby catches up, sometimes causing us to dip into the stored supply. Everybody gets nervous when that happens, but we expect that the baby to catch up. Doesn't mean we like it-- I saw every frozen bag thawed as a sign of failure. Really-- thank goodness I married a psychiatrist.
Remember to take care of yourself: drink until your thirst is quenched (but not more than that--too much water decreases supply!), sleep (nothing fixes problems like a good nap) and give yourself a break. Keep in mind that about 20% of the women in the US never even try breastfeeding. It's the right thing to do and often the right thing to do is not easy.
Fenugreek: This is a non-prescription herbal supplement that increases milk supply by decreasing an inhibitor of prolactin. It may also decrease blood sugar. Fenugreek can make you smell like maple syrup and can upset your stomach. The starting dosage is 1 or 2 600-625 mg capsules every day for a few days. If you have no stomach upset, then bump up the dose to 3 capsules three to four times a day. In my experience, Fenugreek helps those mothers who have insulin resistance issues more than other mothers.
Domperidone: This one, in my experience, works well, especially if you are already making milk; for women who have had issues establishing a supply, I have not has as much success. You need a prescription to obtain it in the US. The FDA had issued a warning about this medication some time ago. Since then, more evidence on the safety of the medication has been released. I continue to think that it is a much safer and more useful medication than Reglan, which is sometimes offered as an alternative. Reglan, unlike Domperidone, can cross the blood:brain barrier and cause women who are taking it to become tired and depressed, a combination I'd like to avoid.
This is only available by prescription. I'll write it for the moms of my patients. The usual dose is 10 mg 3-4 times a day and it needs about 7-10 days or so to kick in. You need to talk to your doctor if you are interested in this one and you aren't my patient. If you aren't in my practice, but would like the medication, I can see you in consultation. Domperidone is not currently covered by insurance.
Reglan (metaclopromide) This one is covered by insurance, but I've had less luck with it. In fact, I'm not using it much , if at all, anymore. It's similar to Domperidone, in that it is a prescription GI drug that also increases milk supply, but it has some theoretical side effects that most of us find annoying: fatigue and depression. Those of you I've had on this had some modest improvement in your supply, but many of you were really tired.
The dose I usually use is...nevermind...too many side effects to even recommend a dose.
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