topical tuesday #1 - breastfeeding, galactagogues and regaln warning

(edited to add more info thursday september 3)

have i mentioned i changed my weekly plan a bit? i'm doing topics in childbirth education on tuesdays and thursdays now....

on to todays topic "breastfeeding, galactagogues and reglan warning"

many many new mamas think they have a low milk supply. in fact according to this study

http://bit.ly/i95oY

"The perception that their infant was not satisfied by breast milk alone was cited consistently as 1 of the top 3 reasons in the mothers' decision to stop breastfeeding regardless of weaning age (43.5%–55.6%)"

(most have a fine supply btw)

Now the best wy to asess milk supply is by observing weight gain and counting wet and poopy dipes.

the world health organization has new weight gain charts based on breastfeeding you can refer to. heres the one for girls http://www.who.int/nutrition/media_page/cht_wfa_girls_z_0_5.pdf and heres the one for boys http://www.who.int/nutrition/media_page/cht_wfa_boys_z_0_5.pdf

and heres a quick diaper counting link from kellymom http://www.kellymom.com/bf/supply/enough-milk.html (basically you want to see 6 or more wet dipes a day and at least 1 poopy dipe, though younger infants, less than a month old often have several little poops each day rather than 1 big one)

if your baby isn't gaining and isn't wetting and pooping it could be a supply issue. ( it could also be transfer issue - you could be making milk and s/he isn't taking it in ) in either case please see a healthcare provider to be sure baby is ok and see a lactation counselor or a lactation consultant to check for breastfeeding issues such as a bad latch.

if you determine a low supply is the culprit there are lots of ways to increase your supply but the simplest is just to nurse.

• if you can arrange to spend a day or several in bed skin to skin with your babe that will often do the trick.
• be sure to offer both sides before you call it quits on any one nursing session.
• even if you have a sleepy baby be sure you wake him or her up every 2-3 hours to nurse

if increasing the time you spend nursing your little one doesn't increase supply you can add a pumping session or several into your routine.

and there are foods, herbs and medications that can increase supply if necessary. heres another link from kellymom http://www.kellymom.com/herbal/milksupply/herbal_galactagogue.html that gives a good list of various galactagogues and the dosages and side effects

and that leads me to the warning portion of this post: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm149533.htm

Reglan or metoclopramide is a drug used to treat reflux and other gastric conditions but it also increases milk supply. it is not fda approved for use as a galactagogue but is often used as one.

from the fda release linked above:

"Current product labeling warns of the risk of tardive dyskinesia
with chronic metoclopramide treatment. The development of this condition is
directly related to the length of time a patient is taking metoclopramide and
the number of doses taken. Those at greatest risk include the elderly,
especially older women, and people who have been on the drug for a long
time.
Tardive dyskinesia is characterized by involuntary, repetitive
movements of the extremities, or lip smacking, grimacing, tongue protrusion,
rapid eye movements or blinking, puckering and pursing of the lips, or impaired
movement of the fingers. These symptoms are rarely reversible and there is no
known treatment. However, in some patients, symptoms may lessen or resolve after
metoclopramide treatment is stopped."