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 you start to drop off a little, dipping into the stored supply.  Everybody gets nervous when that happens, but we expect that drop-off to occur.  Doesn't mean we like it-- I saw every frozen bag thawed as a sign of failure.  Really-- thank goodness I married a psychiatrist.

There is great info on all 3 of these meds on www.breastfeedingonline.com that I'm not going to repeat here.  I've included the Racine version of how and where to get these below. 

And remember, that along with these, you need to eat protein, 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 a full 50% 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, the hormone that makes milk.   It sometimes makes you smell like maple syrup and can upset your stomach but can really boost your supply.  In fact, this stuff is good enough where we may not have to do anything else to increase your milk supply.  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 Racine, we have found fenugreek at GNC. Blessed thistle, another herbal supplement,  can help with the stomach upset if it occurs.

Domperidone:  This one is awesome too, but is a prescription.  If your breast has made milk, just as it will with fenugreek, it will make more milk with this.  The FDA has issued a warning about this medication, since reivsed and I continue to think that it is a much safer and more useful medication thatn REglan, which is sometimes offered as an alternative.   Here's the warning and the rebuttal by the foremost expert on lactation pharmacology...response from Dr. Tom Hale.  Again, www.breastfeedingonline.com has great info.

This is only available by prescription. I'll write it for the moms of my patients.  The usual dose is 20 mg 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. 

We get it from MD Custom RX .   It isn't covered by insurance, but their price is better than any other in the state.  They will mail it to you or you can go get it. 

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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