Very low supply, normal prolactin levels, will domperidone help?

[growgrowgrow]

So this is my second baby and I've had supply issues with both - even with a beautiful latch, and perfect positioning, and nice long nursing sessions, neither babe ever transferred more than .5oz milk from my breast even feeding over an hour.  I have tried all the usual methods of increasing supply, have been seeing a lactation consultant, and had to start supplementing at day 8 using the SNS.  Baby is 19 days old and my supply has not budged.

I had prolactin level drawn and it was 183.6, about 15 minutes after finishing nursing, at 9AM.  This is in the normal range, I'm told.

I was able to fill a prolactin prescription at a compounding pharmacy and have just taken the first dose.  I am just wondering if anyone else had a similar supply issue, with normal prolactin level, and had domperidone actually help?  It seems to me that if my prolactin level is normal, the issue must be with breast tissue or the receptors.  Any ideas?

Thanks!

[PatioGardener]

nak so this will be short

sorry you are dealing with this!

i have heard the dom can help to 'max' milk production even with normal prolactin levels.

are you able to pump? it only helps if you can remove the extra milk, or your body down regulates.

just a thought - have your babies been checked for a tongue-tie (anterior or posterior) by someone who really knows tongue-tie? that could explain the low transfer rate.

good luck!

[Momtotherue]

If you suspect it's a glandular tissue issue, you might consider taking goatsrue tincture. I have PCOS and part of my supply problem was insufficient tissue and I swear after a few weeks on this stuff my boobs got all kinds of lumpy and bumpy with breast tissue. You can go to motherlove.com to purchase it.
I think it couldn't hurt to try the domperidone because I think it does kick your milk making into gear. Even if you're within normal range, it could be low normal?
Motherlove also sells a tincture called more milk plus which has fenugreek and all kinds of other herbs in it that work as galactagogues. If you don't want to jump to the domperidone right away you can also try that as a more natural approach.
Keep up the good work! You're doing a fantastic job so far!

[Megan73]

It's so frustrating to be doing everything right and not seeing your supply go up. I'm sorry you're going through it.
Have you read "Making More Milk" by Diana West and Lisa Marasco? It has lots of great info on reasons for low supply and what can help. According to the book, your prolactin level should be 200 in the first 10 days postpartum and 400 with suckling - taken 45 minutes after starting to pump or nurse.
Honestly, I would try the dom. It's so safe and has so few side effects (some women find it makes them hungry and hence gain weight - I never have) that it can't hurt. It works best with really thorough milk removal so I pumped after feeds with a hospital grade pump then used what I pumped to supplement.
PPs have made great suggestions but my #1 advice would be to invest in some Lact-Aid units. You can buy them online and they're exponentially better than the Medela SNS for long-term supplementation.
Kudos to you, mama, for using an at-the-breast supplementer. Your babe may not be exclusively breastmilk fed but he's exclusively breastfed as far as he's concerned!

[sotaguchimuch]

I am a FTM, baby was a planned homebirth, arrived on July 16th. The lack of wet diapers led us to an LC who said I had low milk supply. I was given a Medela SNS & have been using it for every feeding. Pumping with a hospital pump and I can get 3 eye dropper fulls MAX.

I am at a loss for what to do and I'm broken hearted that my body is not producing enough milk for my baby. We're meeting with the ped today & I'm planning on asking about dom.

Megan73--you said "my #1 advice would be to invest in some Lact-Aid units. You can buy them online and they're exponentially better than the Medela SNS for long-term supplementation.".... I have found the SNS to be very cumbersome and just an all around pain in the butt. I googled Lact-Aid unit but couldn't find what you were referring to. Can you point me in the right direction?

[gemasita]

Originally Posted by sotaguchimuch 

I am a FTM, baby was a planned homebirth, arrived on July 16th. The lack of wet diapers led us to an LC who said I had low milk supply. I was given a Medela SNS & have been using it for every feeding. Pumping with a hospital pump and I can get 3 eye dropper fulls MAX.

I am at a loss for what to do and I'm broken hearted that my body is not producing enough milk for my baby. We're meeting with the ped today & I'm planning on asking about dom.

Megan73--you said "my #1 advice would be to invest in some Lact-Aid units. You can buy them online and they're exponentially better than the Medela SNS for long-term supplementation.".... I have found the SNS to be very cumbersome and just an all around pain in the butt. I googled Lact-Aid unit but couldn't find what you were referring to. Can you point me in the right direction?

Here you go:  http://www.lact-aid.com/

Sorry you guys are having problems too.  I also had a homebirth, everything went perfectly, and I had low supply right from the start.  DS is 6 months old now and we haven't found a cause.  I do think my supply is up some but not enough to stop supplementing with donor breastmilk (which I highly recommend if you know another mama with extra).

[growgrowgrow]

thanks for all the input.  i'm now 5.5 weeks postpartum.  i took the domperidone for two weeks and it did nothing.  i have also been taking fenugreek and more milk plus special blend (motherlove).  i since weaned myself off of the supplements because my stomach could not handle it, and have noticed zero difference in supply, so at least i am steady.  i am pumping with a hospital-grade pump.  up until 4 weeks pp we supplemented with formula only using the SNS but at that time i made the decision, given the fact i had had no increase in my supply, to start using bottles instead.  this has saved a lot of my sanity.  the SNS is a huge PITA to use at every feeding.  if i had had any indication that my supply would increase i may have kept it up, but i honestly think - and so does the LC and OB - that my having been eating disordered during puberty, when my breasts were forming, caused them not to develop with sufficient tissue.

i am sad about the situation, but i am still nursing on demand before giving her a bottle (at each feeding) and pumping... my supply has not dropped, and she is maybe getting 15 - 20% of her nutrition from me so i can feel good about that, and the fact we have a nursing relationship, and that i have done everything i could and nothing helped (oh and no- baby is not tongue-tied).

sotaguchimuch i hope you are able to find a solution that works for you, and that you feel at peace with.  it is such a blow to not be able to produce as much milk as your little one needs.  i never anticipated having this problem, and it has been quite a journey.  <3

[foreverinbluejeans]

I disagree with the notion that poor nutrition during puberty would cause you to not be able to breastfeed. The human species would not have survived if women that didn't eat enough or "the right things" during breast development couldn't feed their babies. Women that live in horrific conditions and breastfeed their babies. Some women do have abnormal breasts and before formula their babies would have to be fed by another woman or the baby would die. It's very rare for women to have breasts that are so abnormal that they can't breastfeed and usually they look abnormal. You do not need to feel guilty that something you did as a teen made your breasts abnormal and you can't breastfeed.

When you breastfeed there is no accurate way to tell how much milk a baby gets. Even weighing before and after feeding on very accurate scales in a hospital nursery is not considered by health care providers as an accurate measure. My 3 children and grandson have a rare genetic disease that involves growth and I have a lot of experience with  breastfeeding and weight gain. The best way to tell if your baby is getting enough is by weight gain. Babies should gain about 4 ounces a week or a pound a month during the first 6 months. If you aren't going for weekly weight checks (we went 3 times a week) at the hospital or doctor's office you can buy scales. Babies can over feed on supplemental formula and gain too much. You want your baby to have as much breastmilk and as little formula as possible.

You said you are using a hospital grade pump. Some people think pumps like the Pump in Style are hospital grade. What hospital grade refers to is the rental pumps. The rental pumps are the best and it may make a difference. Using massage like the Marmet technique before pumping can improve the amount you can pump. You can actually condition your let-down reflex with meditation like Pavlov's dog. Frequency of nursing or pumping may be more important than the length of the feeding session. It's normal for babies to seem to be nursing all the time.

Keep talking to people and you may find things to try that you haven't thought of. I wore my babies in a sling with only a diaper on and my shirt unbuttoned (no bra) at home so they had lots of skin-to-skin contact. I got good at arranging the sling and my clothes so that I was covered up. You might consider getting milk from MilkShare or mothers in your community.

[growgrowgrow]

i know tone can get lost on the internet, but your post comes across as pretty condescending even if you did not intend it as such.

just briefly... i have read several studies that women who were anorexic during puberty have had subsequent breastfeeding issues.  my breasts do look abnormal, and they did not ever grow with pregnancy, and i actually don't feel guilty about having had an eating disorder even if that caused me not to be able to breastfeed.  it is a disease just like cancer, should i feel guilty if i had had cancer and couldn't breastfeed?

the hospital-grade pump i have is one i am renting from a hospital.  it is a medela lactina select. 

we did the before-and-after weights after full hours of feeding and she transfers 1/2 oz.

and she lost more than 10% of her body weight... not sure the exact percentage, but it was a pound and a quarter in a matter of days. 

more later...
 

Originally Posted by foreverinbluejeans 

I disagree with the notion that poor nutrition during puberty would cause you to not be able to breastfeed. The human species would not have survived if women that didn't eat enough or "the right things" during breast development couldn't feed their babies. Women that live in horrific conditions and breastfeed their babies. Some women do have abnormal breasts and before formula their babies would have to be fed by another woman or the baby would die. It's very rare for women to have breasts that are so abnormal that they can't breastfeed and usually they look abnormal. You do not need to feel guilty that something you did as a teen made your breasts abnormal and you can't breastfeed.

When you breastfeed there is no accurate way to tell how much milk a baby gets. Even weighing before and after feeding on very accurate scales in a hospital nursery is not considered by health care providers as an accurate measure. My 3 children and grandson have a rare genetic disease that involves growth and I have a lot of experience with  breastfeeding and weight gain. The best way to tell if your baby is getting enough is by weight gain. Babies should gain about 4 ounces a week or a pound a month during the first 6 months. If you aren't going for weekly weight checks (we went 3 times a week) at the hospital or doctor's office you can buy scales. Babies can over feed on supplemental formula and gain too much. You want your baby to have as much breastmilk and as little formula as possible.

You said you are using a hospital grade pump. Some people think pumps like the Pump in Style are hospital grade. What hospital grade refers to is the rental pumps. The rental pumps are the best and it may make a difference. Using massage like the Marmet technique before pumping can improve the amount you can pump. You can actually condition your let-down reflex with meditation like Pavlov's dog. Frequency of nursing or pumping may be more important than the length of the feeding session. It's normal for babies to seem to be nursing all the time.

Keep talking to people and you may find things to try that you haven't thought of. I wore my babies in a sling with only a diaper on and my shirt unbuttoned (no bra) at home so they had lots of skin-to-skin contact. I got good at arranging the sling and my clothes so that I was covered up. You might consider getting milk from MilkShare or mothers in your community.

[growgrowgrow]

i should have waited to reply until i had more time.  :-)  sorry about that.  i meant to say, we have done the before / after weights and the most she transfers is half an ounce in an hour.  we were doing weight checks several times a week as well b/c the pediatrician and LC and myself all wanted to avoid formula supplementation, but ultimately baby was starting to get dehydrated, not enough wet or messy diapers... etc.

to me, the decision to use milkshare or not is extremely personal and not for everyone.  i have given it a great deal of thought and it is just not something i am comfortable with for a number of reasons.  of course, i don't like using the formula either. 

i guess i just get frustrated with the idea people seem to have that i am somehow uneducated or i would be successful at breastfeeding.  prior to #1 i had had it drilled into my mind so much that nearly every woman can breastfeed, those that can't are not getting proper support or are just not doing the right things or are ignorant.  i have read books, gone religiously to see the LC (more than one LC actually), gone to the OB, had my bloodwork done, tapped virtually every resource and tried just about everything under the sun that has been suggested to me.  in my case it is not for lack of trying, or lack of support... there is honestly some reason it is not working, that seems to be because of insuffient glandular tissue. 

it is just frustrating... it has been a really difficult and emotional journey.  i was crushed this time around to have the same issues.  the good news is i do have *a* nursing relationship with my baby, and i am still nursing her, and i have found some kind of equilibrium that works for my family.

[PatioGardener]

Originally Posted by Megan73 

Kudos to you, mama, for using an at-the-breast supplementer. Your babe may not be exclusively breastmilk fed but he's exclusively breastfed as far as he's concerned!

[fnpmama]

Originally Posted by growgrowgrow 

i should have waited to reply until i had more time.  :-)  sorry about that.  i meant to say, we have done the before / after weights and the most she transfers is half an ounce in an hour.  we were doing weight checks several times a week as well b/c the pediatrician and LC and myself all wanted to avoid formula supplementation, but ultimately baby was starting to get dehydrated, not enough wet or messy diapers... etc.

to me, the decision to use milkshare or not is extremely personal and not for everyone.  i have given it a great deal of thought and it is just not something i am comfortable with for a number of reasons.  of course, i don't like using the formula either. 

i guess i just get frustrated with the idea people seem to have that i am somehow uneducated or i would be successful at breastfeeding.  prior to #1 i had had it drilled into my mind so much that nearly every woman can breastfeed, those that can't are not getting proper support or are just not doing the right things or are ignorant.  i have read books, gone religiously to see the LC (more than one LC actually), gone to the OB, had my bloodwork done, tapped virtually every resource and tried just about everything under the sun that has been suggested to me.  in my case it is not for lack of trying, or lack of support... there is honestly some reason it is not working, that seems to be because of insuffient glandular tissue. 

it is just frustrating... it has been a really difficult and emotional journey.  i was crushed this time around to have the same issues.  the good news is i do have *a* nursing relationship with my baby, and i am still nursing her, and i have found some kind of equilibrium that works for my family.

Hugs mama - I could have written this myself and I have shared your frustration.  I have IGT and never produced more than 4oz in 24 hours, with either of my first 2 sons.  I am glad you have found some equilibrium that works for your family.  Also, there are some other mama's on the IGT & second time mama's thread in this forum that have been through the same thing.
 

[bigmommylove]

I would definitely try something herbal to see if that helps with your milk supply. There are a lot of options out there, I would definitely use something that has more than one herb. I personally use Breastea and it has worked great for me. Hang in there.