Here is a summary of a consult that I did with a mother through a lactation
program yesterday.  This mother does not live in my city--Tampa, FL.  I would
love to get feedback on this story.  Confidentiality has been maintained....

    In accordance with our phone conversation this afternoon, I  am providing
a summary of my communication with Jane Doe -on 5/7/02.  I had contacted her
at approximately 4 p.m. EST. to complete a Week 1 MLS that was interrupted by
the baby on 5/4/02.  She said she would call me back, and I gave her 3 days
before I decided to follow-up.  There appeared to be no nursing problems on
5/4/02.

      On 5/7/02, I asked her how she was doing, and she told me that things
were terrible.  Her OB had seen her today, and told her that her engorgement
was so severe that, at this point, the only way to solve the situation was to
wean immediately and take an anti-biotic.  She was quite distressed because
she still wanted to breastfeed, but she also respected her doctor's opinion,
and to a certain extent she also wanted this pain to end. I basically
informed her that Lactation Consultants have a lot of experience working with
very severe engorgement, and rarely (if ever?) is it recommended that a
mother wean immediately to treat engorgement.  I asked her if she had seen a
Lactation Consultant, and her response was that she had called an LC at her
local hospital who gave her instructions on how to reduce the
engorgement--and it wasn't working.  That is why she saw the OB today.  By
this point, she had full-blown mastitis.

      The OB directed her to stop pumping, so she had not pumped at all since
this morning.  Although her breasts were severely sore, her nipples were not.
 She told me that she was on her way out the door to pick up the anti-biotic,
and "dry-up" pill that the doctor prescribed.  I asked her, "Did he prescribe
parlodel?"  She said that that was not what it sounded like.  However, since
I sounded concerned, she asked if there was a problem, and basically
explained that paradol was no longer considered safe by the FDA for the
purpose of helping mothers dry their milk supplies.  At that point, I asked
her if she would be willing to call me when she arrived at the pharmacy, and
she told me she would.

     In between my phone conversations with her, I phoned my supervisor to
appraise her of the situation.  She approved of the approach that I was using
and suggested that I also tell this mother that we would also reimburse her
the cost of a lactation consult at her hospital, should she decide to see an
LC

      The doctor prescribed ampicillin, percocet, and bromocriptine
(parlodel!).  I was personally LIVID that an OB practicing in the year 2002
would still prescribe parlodel for the purpose of "drying up", but I
maintained professional composure and read about and discussed each drug.
All she needed to hear was the first paragraph about parlodel on page 80 in
Medications in Mother's Milk (9th ed., 2000) by Thomas Hale:

      "Bromocriptine is an anti-parkinsonian, synthetic argot alkaloid which
inhibits prolactin secretion and hence physiologic lactation.... The FDA
approved indication for lactation suppression has been withdrawn, and it is
no longer approved for this purpose due to numerous maternal deaths,
seizures, and strokes" (Hale, p. 80).

      She decided to take the ampicillin and percocet, and definitely forego
the parlodel. She told me that today was too intense, but that she had full
intentions on seeing an LC tomorrow (5/8/02)  I suggested that she also
follow the directions provided by the hospital LC again.  The anti-biotic and
anti-pain medication should help.  On a personal note, I would prefer she
take ibruprofen for the pain instead of percocet, but I am not the doctor.

      We discussed using heat and cold packs to reduce engorgement.  However,
she did have flu symptoms at the time (including the chills), so the ice
might be difficult to manage until the chills subside.  It is also my
professional opinion that this mother's engorgement was made even more severe
by the actions of her OB on 5/7/02, and that prescribing parlodel is an
action that is beyond inappropriate. This mother was sincerely grateful that
I had called her today, and she said that God must have sent me because she
was on her way out the door to pick up the medication when I called.  She was
very appreciative for my help and assistance.  It is my plan to call this
mother for follow-up on 5/8/02.

Debbie Albert, Ph.D, IBCLC
Tampa Lactation Counseling
Tampa, FL

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