Breastfeeding Outside the Box

  Cathy, like so many other non-birthing parents wanting to induce lactation or relactate, is trying to unravel all of the varying information she has received.  So she emailed us for help.  When I suggested we might share her email on the podcast so that we could help others in her shoes, Cathy agreed.  This podcast episode is devoted to addressing Cathy's questions, concerns, and confusion around the basics of how to induce lactation/relactate -- and you might find it addresses some of yours as well!  Below is the email that is the inspiration for today's episode: I am 38 and have an almost 3-year-old son whom I nursed from birth-22 months. We are in the process of adoption.  We are in process of our homestudy and imagine we'll be bringing an infant home within 9-12 months.  I am eager to relactate for this baby.  I have spoken with two of our local IBCLC's.  One suggested the Newman-Goldfarb protocol, and the second suggested I contact you.  My GP suggested I talk to my ob/gyn for the prescriptions and my ob/gyn said the only way to relactate is via pumping.  As you can imagine, I am a bit frustrated.

For as long as I've known my podcast co-host Hope Lien, she has been my go-to person for questions about at-breast/chest supplementation.  When nursing her daughter by adoption (pictured here), at-breast supplementation was a key to her success - as it is for most parents who need to provide long-term supplementation.  She understands first-hand how frustrating at-breast/chest supplementation can be at the beginning and how invaluable it can be in the long run.  Getting from frustration to long-term success is the key and Hope tells us how!   View full show notes Here: http://sweetpeabreastfeeding.com/podcast/52-at-breastchest-supplementation-tips-and-more

It's a case study!  Something a little bit different in our discussion with Dr. Nice, our pharmacist expert.  Alyssa had connected with a mom-to-be Courtni who was inducing lactation with very quick and abundant milk production.  She wanted to figure out what Courtni was doing so that she could learn from Courtni's experience to help other parents.  (We at Sweet Pea are always trying to learn more about how to support the nursing success of non-birthing parents!)  ... but Alyssa could not find anything in Courtni's approach that was different than other parents she had worked with.  She did observe, however, that Courtni was taking several medications for her own health issues.  Alyssa wondered if these medications or the health conditions underlying them could be the secret to Courtni's outcomes.  She went to her friend, Dr. Nice for the answers... View full show notes here: http://sweetpeabreastfeeding.com/podcast/51-ask-dr-nice-a-case-study-on-the-impact-of-parents-medications-on-milk-production-when-inducing-lactation

As it turns out, breastfeeding is not just "A Womanly Art."  Steph shares an incredible story about a same-sex male couple she worked with who both nursed their baby, exclusively providing human milk for baby's first 6 months.  How does this work?  Creativity, support, milk expressed by baby's gestational carrier, and a tiny feeding tube at the father's nipple.  Steph gives us the details of this amazing nursing relationship and how to support any LGBTQIA family interested in breastfeeding/chestfeeding/nursing. Check out the full show notes here: http://sweetpeabreastfeeding.com/podcast/50-stephanie-wagner-ibclc-on-chestfeeding-and-supporting-the-lgbtqia-community

With the FDA warning against domperidone, we have noticed an increasing number of U.S. parents who choose to induce lactation or relactate without using the pharmaceutical medication domperidone.  While we have spent many episodes discussing the safety and effectiveness of domperidone, our ultimate goal is to  meet each parent with a plan for inducing lactation or relactation that is consistent with their preferences.  In this episode Alyssa and Hope discuss alternatives to domperidone and how milk production may be impacted by a lactation plan that does not include dom.   Full Shownotes available at: http://sweetpeabreastfeeding.com/podcast/49-ditching-the-dom-inducing-lactation-or-relactating-without-domperidone

For breastfeeding parents, safely taking medications - whether they are for the parent's health or for increasing milk production - can be complex.  It is a delicate balance between the parent's health, the safety of the milk for the baby, and the importance of breastfeeding.  It involves communication between the parent's health care providers, the baby's health care providers, and the pharmacist who can help to put it all together.  Here our friend and pharmacist with a ton of experience with lactation, Dr. Frank Nice has more answers.   ​On today's episode, we asked Dr. Nice questions such as: ​How to understand safety of medications when a parent is taking several of them.  Can we simply look at each one individually or is there a combined impact? ​What if both parent and baby are taking medications - do we need to consider the safety of how those medications interact in combination? ​When a parent is making less than a full milk supply, will the amount of the parent's medication in the milk be more concentrated or will the baby get less medication because there is less milk?​ ...and more!    

In the US, it is natural that we have a lot of concerns about the safety and side effects of domperidone.  Our Food & Drug Administration has not yet approved this medication (see episode #4 for more on that) so parents are generally obtaining it without a doctor's or certified nurse midwife's prescription*.  That also means that the pharmacist is not able to oversee use of domperidone and how it plays out with other medications that the nursing parent is taking.  That is our unfortunate reality today.  With this in mind, it is essential that parents and lactation professionals understand and take responsibility for possible contraindications and side effects associated with domperidone.  We are extremely fortunate once again to bend the hear of one of the most expert resources on safety and use of pharmaceuticals while breastfeeding, Dr. Frank Nice.

about their co-nursing experience, and with Katie about inducing lactation!  It has been a joy-filled road for them with a few bumps along the way ... including concerns with safety of medications, not always supportive healthcare providers, ​sore nipples, middle of the night challenges, and a bout of baby preferring one mom for bedtime nursing.  With creativity, communication and resourcefulness these two moms have navigated these challenges and now that baby is 10 months old they look back (and forward) to their nursing experiences with much gratitude.  

Dysphoric Milk Ejection Reflex, more commonly known as D-MER, is one of the most severe breastfeeding challenges yet also one of the least known or understood.  D-MER is a feeling of dysphoria caused by the hormonal shift that occurs when the milk releases during nursing, pumping, or any other time a let-down is triggered.  So if you or anyone you know experiences significant negative feelings when milk lets-down, you may want to hear what Alia Macrina Heise has to share.  Propelled by her personal experience with D-MER, Alia has become a clinical expert in the area of dysphoric milk ejection reflex.

Alyssa and Hope get real!  Being a new parent isn't always the blissful joy we might see on holiday cards.  It can be really tough times, as well as wonderful times.  We suggest that the balance lies in self-care.  It can be so difficult to care for ourselves as new parents, and we haven't always done the best job of it ourselves. We hope our stories and discussion will support you and propel you into a holiday season and new year of simple joys and caring for yourself just as well as you already do for your precious little ones. 

While using medications is a science, using herbs for increasing milk production doesn't seem quite as straightforward.  There are so many nuances to consider:  ​How do I know if a particular herb is helpful for me? What form of the herb should I take? ​What about using herbs in combination with domperidone? ​Can taking herbs alone boost my milk production?  Should I even try this? Alyssa discusses these tricky herb questions and more in this Ask Dr. Nice episode.

We are thrilled to re-visit an early podcast interview with Chrissy Fleishman who induced lactation for her baby born via surrogacy.  There are a couple of reasons why we are re-releasing it now.  One, we thought Chrissy gave a great interview.  She is well-informed and enthusiastic, and her experience has followed a fairly typical pattern - if there is such a thing in inducing lactation!  Second, we want to address a particular experience Chrissy shares.  Chrissy had Depo-Provera injections as a young adult in order to help with menstrual difficulties.  She experienced lactation as a side effect. Recently, there has been some information floating around online suggesting the use of Depo-Provera for inducing lactation.  This source cites a 1994 study done in Papua, New Guinea which 11 out of 12 mothers who had induced lactation with the help of a single Depo-Provera injection were able to fully lactate within a few weeks of starting the protocol.  (Nemba, 1994)  We agreed that this study seemed promising, not only because of the high rate of full lactation but also because the protocol described in the study takes much, much less time than other approaches typically used.  Although Alyssa had looked into this study when writing Breastfeeding Without Birthing, she decided it made sense to take another closer look and to contact some other professionals for their advice.  This podcast episode is about what she discovered (and in some cases  re-discovered).

We can't get enough of talking with Dr. Nice about medications for increasing milk production.  Domperidone is at the forefront of our discussion, as usual.  We delve a bit deeper into dosages and side effects of dom with Dr. Nice.   But we don't leave you there:  we know that domperidone is tricky business in the United States right now (since it is not yet FDA approved) and wondered if there may be other medications for increasing milk production that are both safe and more available in the US.  Dr. Nice has the answers!

I first learned about Malunggay (a.k.a. Moringa) as an herb to help with milk production when I was writing Breastfeeding Without Birthing.  When Diana West, IBCLC, author of Making More Milk and internationally known expert on milk production, was reviewing a draft of my book she suggested adding this really helpful herb.  I'm so glad she did!  Since then, I've worked with countless nursing parents who have successfully used this herb  -  whether they are inducing lactation, relactating, or needing to support milk production for other reasons.  During this interview, I chatted with Angela Veloso of Sugarpod Naturals, maker of Go-Lacta malunggay.  She has a rich knowledge and appreciation for this helpful herb, and after listening to her we think you will too!   Read our full show notes at our website http://www.sweetpeabreastfeeding.com/podcast.html ​  

I had a blast talking with SonJoria Sydnor and Denecia Harrell about support for breastfeeding families of color in the St. Louis area and beyond. They talked about the needs around breastfeeding for families of color and how they provide the specific support that is needed. Whether it is through group meetings, home visits, texts, or social media I AM: Breastfeeding is there for breastfeeding families of color in St. Louis. You can read the rest of our show notes here. 

A little something new with Dr. Nice!  We've talked with in the past with Dr. Nice mostly about galactogogues:  medications, herbs, and foods for promoting milk production.  This time we pick his brain about medications the nursing parent may take for herself rather than her milk production.  This includes medications for the nursing parent's health and for her recreation ... such as alcohol and marijuana. See more information on our show notes at: www.SweetPeaBreastfeeding.com/podcast.

Introducing the winners of the 2017 World Breastfeeding Triathlon!  Okay, I just made that up.  But if there was one, this couple would certainly have been a top contender.  Together they have successfully relactated, co-nursed, and nursed triplets.  Add tongue-ties for all of their children and you start to get the picture!  We think you will find this lovely couple as delightful and their story as heart-warming as we did! See more information on our show notes at: www.SweetPeaBreastfeeding.com/podcast.

Dr. Nice is back, and he answers questions about the other half of the galactogogue equation:  herbs and foods that may be used to support milk production.  (Last time we interviewed Dr. Nice, we discussed pharmaceutical medications for increasing milk production.  Check out episode #32.)  We discuss whether to take herbs individually or in combination, whether to consume them in food or separately, and more.  We even get into the relationship between digestion and milk production, and how using galactagogues that support digestion can support milk production as well.  Don't miss this one! See more information on our show notes at: www.SweetPeaBreastfeeding.com/podcast.

We've talked with other adoptive mothers before, but this one is different!  Jennifer brought her daughter home as an older baby and when she finally began nursing, her daughter was 2 years old.  Bringing a toddler to the breast required determination but it was well worth it, according to both Jennifer and her daughter Helina.  (Yes, you'll hear what 8-year-old Helina has to say about her nursing experience in this extraordinary episode!) See more information on our show notes at: www.SweetPeaBreastfeeding.com/podcast.

Because it is our mission at Breastfeeding Outside the Box to support non-traditional families - growing families who have historically not received the information and support they need and deserve - we are so pleased to introduce you to Queer Birth Project.  This is an amazing organization that provides local and online education and resources to both LGBTQ parents and the family building and early parenting professionals working with them. (That includes Lactation Professionals!)  And for families in the Minneapolis area, they hold a local community for new and growing LGBTQ families.  Queer Birth Project is run by Janine, a midwife, and Cheyenne, a doula:  two birthing professionals with a passion for backing growing LGTBQ families.  If you are a prospective or current LGBTQ parent, Queer Birth Project has much to offer you.  If you are a birth or lactation professional wanting to grow a LGTBQ+ practice, Janine and Cheyenne will direct you to your next steps. See more information on our show notes at: www.SweetPeaBreastfeeding.com/podcast.

In this episode, Dr. Frank Nice debuts his first special episode on our podcast! He gives some updates about Domperidone as well as talks about the use of Reglan for parents who want to use these medications to increase their milk production, as well as some of the risks and possible side effects. See more information on our show notes at: www.SweetPeaBreastfeeding.com/podcast.

Ah tongue- and lip-ties!  We've heard A LOT about them from our podcast interviewees.  Hope and I both have children who've had them.  So, while not outside-the-box per se, tongue- and lip-ties affect many babies regardless of any other circumstances and so we wanted to be sure to address them.  Dr. Catherine Sledge is a family dentist who deals a lot with tongue- and lip-tie, and we are so thrilled that she was willing to take the time to talk with us and share her expertise on this very tricky and important issue potentially impacting breastfeeding...and so much more. See more information on our show notes at: www.SweetPeaBreastfeeding.com/podcast.

What do adoption, surrogacy, partnering with a birthing parent, breast/chest surgery, and insufficient glandular tissue (IGT) have in common?  Parents who CAN and DO breastfeed.  In most of these situations, parents will need to supplement their milk production with extra milk or formula in order to meet their babies needs.  How that supplementation goes greatly impacts the long term success of breastfeeding.  So, while we can address how to make the most milk possible, it is also at least as important to address how to work with what milk is there.  In today's podcast, we discuss how to determine whether supplementation is needed, how much to supplement, and tools for delivering the supplement.  See more information on our show notes at: www.SweetPeaBreastfeeding.com/podcast.

I (Alyssa) have had a guilty conscience for a long time.  On this podcast, in my private practice, in my book, and when I speak at conferences, I share breastfeeding guidance that I myself did not take when nursing my babies.  It's not that I am a hypocrite - it is that I just don't want other parents to go through the same struggles that I did.   So why am I sharing this with you?  I want you to know that, just like you, I did not do everything perfectly.  I also want you to know that despite my many mistakes, breastfeeding still turned out well for me in the long run - and it can for you too.    See more information on our show notes at: www.SweetPeaBreastfeeding.com/podcast.

What an opportunity to hear from a medical professional who has brought in milk for her adopted baby.  Deziray's expertise as a physician's assistant gave her added confidence in using a medical approach to inducing lactation.  For her, that worked really, really wonderfully.   She actually had a surplus of milk for her baby that she was able to donate her extra ounces to a friend unable to nurse due to cancer and to several other adoptive families. This degree of milk production is not typical for parents inducing lactation or relactating, but it certainly is exciting to know it is possible! See more information on our show notes at: www.SweetPeaBreastfeeding.com/podcast.

This is a heartwarming interview not only about nursing and parenting under uncommon and in some ways unexpected circumstances, it is also about how parenting can challenge and grow the relationship between parents. Between Amy and Chris, they experienced infertility, inducing lactation, trans masculine nursing, pumping, bottle-feeding and co-nursing.

What do parents most want to know about inducing lactation?  One of the things they most want to know is whether they will be able produce enough milk to meet all their baby's nutritional needs - what we often refer to as "a full milk supply." Most parents who induce lactation produce anywhere from a few drops to a full milk supply.  This is a huge range of results!  So, can we predict how much milk a parent inducing lactation may make?  What factors influence eventual milk production? In today's podcast, Alyssa and Hope discuss these questions and more.  

Mari is a scientist and an innovator ... and an intended mother through surrogacy who nursed her babies.  So when the Medela Supplemental Nursing System - more commonly known as the SNS - wasn't meeting her needs, Mari tweaked it.  She didn't like the way it worked using gravity, got caught on her long hair and glasses when she hung it around her neck, leaked, and was difficult to know whether baby was getting supplement through the feeding tube.  Mari modified how she used her SNS to fix these issues - and now you can too!

We have interviewed several adoptive mothers on the podcast, but Courtney is the first to have actually produced a surplus of milk.  Whereas most mothers who induce lactation need to supplement their milk production, Courtney was able to donate 3000 ounces of the milk she produced by inducing lactation to anther adoptive mom!  Breastfeeding has been such a positive and healing experience for Courtney that she is spreading information and support for adoptive breastfeeding through her new website.  You'll hear more about Courtney's personal experience and her brand new website in this episode.

Sally is an adoptive mom gone lactation consultant, and she uses her personal experiences to guide her professional role with abundant wisdom and compassion.  In this interview, Sally does a beautiful job helping adoptive parents and the professionals who support them to navigate through the particular emotional and logistical challenges adoptive parents may face with breastfeeding. 

Last time we talked with Kristin on the podcast, she briefly mentioned a condition called "insulin resistance" that could cause low milk production.  This was new to us!  We wanted to learn more, and thought you would, too.  On this week's podcast episode we ask Kristin a ton of tough questions about IR. It is a pretty complex topic, with still so many unknowns, but Kristin does an amazing job breaking it down for us.  Once again, we are so thankful for Kristin's lactation expertise, as well as her caring, sensitive approach to new families.

"Calm Down. It's about relationship" That is what Amber Duncan ultimately learned about breastfeeding.  Breastfeeding isn't only about feeding a baby - it is also about the connection nursing facilitates between parent and baby.  This glass-half-full (or breast/bottle-half-full in this case!) attitude allowed Amber to look beyond her own ability to produce milk and find that using a combination of her own milk and donor milk could lead her and her baby to a successful long-term breastfeeding relationship.

"They say to marry your best friend, but what about your breast friend? Our story of laughter, tears, and endless pumping proves that that a couple who breeds together can feed together!" - Bethy Annsa Interested in learning more about trans feminine nursing or co-nursing? We are delighted to share Sparrow and Bethy's beautiful story with you.  

​It was a shock for Rosalie when it was determined postpartum that she had a condition called Insufficient Glandular Tissue, more commonly referred to as IGT.  IGT is a breast condition that makes it difficult - and in most cases impossible - for a nursing parent to produce enough milk to meet all her baby's feeding requirements. Rosalie understands firsthand how difficult this diagnosis can be.  She also understands that it doesn't mean the end of breastfeeding.  Today, as a lactation consultant working with nursing parents with IGT, Rosalie focuses on developing a plan for long-term breastfeeding success, which she believes (and we agree!) is very possible for parents with IGT.  In this week's podcast, Rosalie shares with us about IGT with the heart of someone who has been there and the wisdom of her professional experience.  

When I (Alyssa) began my nursing journey almost 20 years ago, nursing in public was a BIG DEAL.  There would be criticism by others.  There was the dilemma about how and whether to cover up.  It made it pretty challenging to leave the house and still feel like you could meet the needs of your baby.  What really surprises me is that this situation hasn't changed much since then - even though many more parents are breastfeeding now!  But I hope that change is on the horizon. Robin gives us lots of information on how today's new parents can be part of that change to make nursing in public more accessible and comfortable for all. 

This podcast episode is so absolutely rich with information and ideas, no matter what your breastfeeding outside the box situation, you won't want to pass this one up.  Starting with her own "lactastrophe", Kristen shares with us how to find help, causes of low milk production such as insufficient glandular tissue (IGT) and insulin resistance, herbs and medications that can help increase milk production, sources of milk donations, LGBTQ breastfeeding, and more.

​It was a shock for Rosalie when it was determined postpartum that she had a condition called Insufficient Glandular Tissue, more commonly referred to as IGT.  IGT is a breast condition that makes it difficult - and in most cases impossible - for a nursing parent to produce enough milk to meet all her baby's feeding requirements. Rosalie understands firsthand how difficult this diagnosis can be.  She also understands that it doesn't mean the end of breastfeeding.  Today, as a lactation consultant working with nursing parents with IGT, Rosalie focuses on developing a plan for long-term breastfeeding success, which she believes (and we agree!) is very possible for parents with IGT.  In this week's podcast, Rosalie shares with us about IGT with the heart of someone who has been there and the wisdom of her professional experience.  

You are in for a treat with this lovely same-sex female couple who shared the role of breastfeeding their daughter. Rachel and Talana explain that co-nursing has been a delicate balance but with many advantages.  It enhanced the closeness each parent experienced with their daughter.  It made meeting their child's needs easier.  And it strengthened their bond as a couple.  The fact that Rachel is a lactation consultant helped get them though some tough spots - and lucky for many of you, Rachel and Talana's wise words can guide you through as well.

What?! How can you have a "breastfeeding" podcast episode on bottle-feeding?  Well pretty easily as it turns out.  We at Breastfeeding Outside the Box understand that breastfeeding cannot always look like exclusive breastfeeding, and there are many situations in which nursing parents may need to use a bottle to feed their baby.  Through her groundbreaking (and frankly, courageous) efforts, Dee Kassing has developed a method of bottle-feeding that not only doesn't cause the dreaded nipple confusion, flow confusion or flow preference, but actually helps babies with nursing.  Some parents have even called it "therapeutic".  Dee honors us once again with her expertise and wisdom on this week's podcast episode.

How wonderful when a family includes a breastfeeding mother! Well how about if a family includes two of them?  For same-sex female couples, both mothers can share in the nursing of their baby.  This is called co-nursing.  Co-nursing can be such a gift for families, but it also has its challenges.  Rachel is a lactation consultant with personal experience with co-nursing.  She shares her amazing wisdom and insights with us on this podcast episode!

Chrissy is an intended mother, in other words she became a mother via surrogacy.  She tells us of her inspirational journey to nursing her son, from the surprising way she discovered induced lactation to her current breastfeeding relationship with her now 9-week old son.  

In this podcast, we catch up with Alyssa Schnell, co-host of the Breastfeeding Outside the Box podcast and author of Breastfeeding Without Birthing.  We heard a bit about Alyssa's personal story in episode #2.  Now we connect with Alyssa professionally as she shares some of her expertise on breastfeeding-without-birthing ... or breastfeeding in situations of adoption, surrogacy, foster care, co-nursing, relactation, and more.

Some babies seem to be born knowing exactly what to do at the breast.  And for some others...well, latching comfortably and getting milk from the breast isn't so easy.  Lots of times, mothers feel that they have done something wrong when this happens, when in fact their babies are born with some extra challenges.  That was certainly the case with Becca's baby.  But Becca was resourceful and determined, and with the help of some amazing local professionals she gradually and lovingly transitioned her baby from exclusive bottle-feeding to breastfeeding.  We are so grateful that Becca has shared her amazing journey with us!

Becca didn't give up.  When breastfeeding got off to a tough start and her milk production dwindled, she knew in her heart it wasn't too late.  With time, hard work, and determination Becca brought her milk back after she had lost it -a process called relactation.  She used a breast pump, medications, herbs, and the help of a myriad of local professionals.  And one pump at a time, one ounce at a time, she eventually built her milk production up to a full supply.

If there was a queen of breast pump flanges it would be Dee Kassing.  I'm serious.  Dee knows A LOT about breast pumps and their flanges. What is a breast pump flange?  The flange is the clear plastic funnel-like piece that a mother places on her breasts to draw in the nipple and some of the areola in order to extract and collect milk.  But why does using the right flange matter very much?  Dee explains that using the right flange for you results in the most comfort and milk output.  If you are regularly using a breast pump to provide milk for your baby, this podcast episode is a must!

Hearing from Bridget and her husband Shawn will blow you away.  This incredible couple shares their touching journey through a cancer diagnosis during pregnancy, cancer treatments that did not allow mom to breastfeed, and a baby who would not accept his wet nurses or a bottle, Together this mother, father and baby discovered a solution that helped heal them all. Finger-feeding ended up not only being a way for this couple to nourish their baby, but a way to nurse their baby when traditional nursing was not available.  No milk production required.  No breasts required.  Just a finger, a feeding device, and love.

We are so thrilled to have the wonderful Diana West on Breastfeeding Outside the Box.  Through her writing, speaking, and individual work with breastfeeding families, Diana has opened the doors to breastfeeding for so many parents, starting with mothers breastfeeding after breast reduction surgery.  Her influence then grew to supporting mothers with low milk production for various reasons.  And she is now expanding the understanding and support for breastfeeding/chestfeeding for the transgender community.  

We are thrilled to have had the opportunity to interview Jo Lockhart, nursing mother, doula, and creator/moderator of the Supply Line Breastfeeding Awareness Project Facebook page.  In this interview, Jo shares her early struggles with breastfeeding and how using a supply line (a.k.a. at-breast supplementer) has been a key element in her successful nursing relationships with her two youngest children.  Jo is now a pioneer for supply line feeding for mothers with low milk production all over the world.   Cry and celebrate along with Jo as she shares her inspirational journey in this monumental podcast episode.   

Domperidone is a pharmaceutical medication that can help increase milk production.  In this interview, Frank Nice gives us the scoop on "dom".  He tells us who might benefit from domperidone and who shouldn't take it.  He tells us about common - and some not-so-common side effects.  We learn what dosage is ecommended, and how to safely and effectively discontinue using domperidone when the time comes.  And of course we discuss the big controversy around domperidone - why it is not currently FDA approved and where we are in the process of getting  it approved.  ​   Listen to Dr. Nice's interview:   Here are a few highlights from our interview: General dosage of domperidone is 10-20mg 4 times per day or 30mg 3 times per day.  Increasing the dosage can further increase milk supply, but dosages greater than 120mg per day rarely result in additional milk production (although a few mothers have found dosages up to 240mg per day are effective).  Although most mothers who will get a boost in milk production from domperidone notice a difference within a few days, it can take up to 4 weeks for domperidone to have an effect on milk production for some mothers. Although risk of cardiac arrythmia is stated by the FDA as a reason they have not approved domperidone, metoclopromide (aka Reglan) has the same very low level of risk and it is FDA approved. While domperidone is currently in orphan drug status in route to becoming FDA approved as a medication for breastfeeding mothers, there is also a push for FDA approval for domperidone as a treatment for gastroparesis and this may happen even sooner. Right now, we can expect to wait another 3-4 years before domperidone is FDA approved. ​     Not only is he a wealth of knowledge, Dr. Nice lives up to his name with a huge heart for mamas and babies.  We are thrilled to add this amazing interview to our podcast stream.  Find out more about Dr. Nice and his work at www.nicebreastfeeding.com      About Dr. NiceDr. Frank J. Nice has practiced as a consultant, lecturer, and author on medications and breastfeeding for 40 years.  He holds a Bachelor’s Degree in Pharmacy, a Masters Degree in Pharmacy Administration, Masters and Doctorate Degrees in Public Administration, and Certification in Public Health Pharmacy.  He retired from the US Public Health Service after 30 years of distinguished service. Dr. Nice practiced at the NIH and served as a Project Manager at the FDA.  He recently retired after 43 years of government service and currently is self-employed as a consultant and President, Nice Breastfeeding LLC (www.nicebreastfeeding.com).Dr. Nice has published Nonprescription Drugs for the Breastfeeding Mother, 2nd Edition and The Galactogogue Recipe Book. Dr. Nice has also authored over four dozen peer-reviewed articles on the use of prescription medications, Over-the-Counter (OTC) products, and herbals during breastfeeding, in addition to articles and book chapters on the use of power, epilepsy, and work characteristics of health care professionals. He has organized and participated in over 50 medical missions to the country of Haiti. Dr. Nice continues to provide consultations, lectures, and presentations to the breastfeeding community and to serve the poor of Haiti.

It was great to hear from our show's co-host, Hope, about her inspiring journey to nursing her daughter by adoption.  Hope originally learned that breastfeeding in adoption was possible during her doula training.  Armed with the knowledge that breastfeeding would be possible for her even though she   was unable to conceive, Hope found resources on adoptive breastfeeding to be pretty scarce at first.  Fortunately, more information and support continued to emerge.  Here are some of the top resources that Hope found: The asklenore website* got her started with a step-by-step approach for inducing lactation, called the Newman-Goldfarb Protocol.  The Newman-Goldfarb Protocol primarily consists of pumping and the use of pharmaceutical medications to induce lactation. Several months later, Hope discovered additional options for inducing lactation in the newly released book, Breastfeeding Without Birthing.  Using some ideas she read about, she choose to enhance the steps in the Newman-Goldfarb protocol by adding some natural techniques, such as herbs and acupuncture Hope also discovered an amazingly supportive and informative Facebook group called Adoptive Breastfeeding. Hope consulted with a local International Board Certified Lactation Consultant (IBCLC) to help guide and support her as she induced lactation, and then with nursing once her baby arrived.  To find an IBCLC in your area who works with mothers through adoption or surrogacy, see the Find a Lactation Consultant page on the Breastfeeding Without Birthing website. *Note: Updates to increase the simplicity and safety of the Newman-Goldfarb protocol were published in Breastfeeding Without Birthing. Details regarding these updates can be found on the Breastfeeding Without Birthing blog.   SupplementationWhen Hope started the process of inducing lactation, she was hoping to achieve a full milk supply.  But, like most mothers who induce lactation, she did produce a significant amount of milk but not a full supply.  Knowing how much to supplement can be tricky - not enough supplemental milk or formula means baby won't have enough to eat, but too much supplemental milk or formula can mean less breastfeeding.  Looking back, Hope wonders if she supplemented too much too early.  Her pediatrician recommended supplementing 3 ounces per feeding within her daughter's first few days of life, but this recommendation was way more milk/formula than a baby needs in total at that age: At 3 days, normal intake during a feeding is 1 ounce. At 1 week, normal  intake during a feeding is 1.5 ounces. At 2 weeks, normal intake during a feeding is 2-2.5 ounces. At 1-6 months, normal intake during a feeding is 3-4 ounces [Mohrbacher & Kendall-Tackett, 2010]If a mother has induced lactation with pumping before her baby arrives, she will have a pretty good idea how much milk she is producing at a feeding, and can use the difference between her milk production and the normal intake numbers above as a starting point on how much to supplement.