Kika
It sounds as if you're working with a really
difficult case and as if the parents are very
highly motivated to do the best for both of their compromised children.
Obviously, I'm not a doctor, but I've had a _lot_
of experience with mothers who were prescribed
sulpiride (50mg three times daily) to assist with
breastmilk production - that's to increase the
quantity of the milk produced, and to assist with
problems that were thought to be due to anxiety,
eg delayed letdown, mild depression, anxiety to
do with the baby or making milk etc.
Although sulpiride is not used in the USA and
Canada, it is prescribed for mental health
difficulties in the UK and Europe, as far as I
know. And it is commonly used as a galactogogue
in South Africa, Zimbabwe and Chile. I worked as
an IBCLC in private practice in Zimbabwe from
1990 to 2003, and at one time a little
mini-survey showed that a full 25% of my clients
had been prescribed sulpiride to help with
breastfeeding either in the current or a previous
lactation. It got to the point that I felt I
needed to develop a handout to caution mothers
about over-use of this drug since they would be
able to receive a Rx for sulpiride (pills to make
milk) literally "on demand". They would also
share tablets between friends and relations, ie
taking this drug that had not been prescribed for
them but rather on the recommendation (and gift)
of other mothers.... Last year I worked with a
mother in a surrogate breastfeeding situation
whose OB in Johannesburg prescribed sulpiride for
her in order for her to induce lactation for her
baby. She lived in UK, and was working in
various African countries, hence the OB in South
Africa, and he became quite bossy with her (in a
friendly way) when she expressed reservations
about sulpiride, saying it was the most effective
drug that he know of. She was persuaded :-),
took it and started producing drops of milk (as
was my experience in other cases) within 4 days.
As far as I know sulpiride works as am extremely
effective galactogogue by increasing prolactin
levels. It is also an anxiolytic. The usual
course is for 2 weeks initially and a low dose,
rather than a high dose, seems to be most
effective. But - very important - it needs to be
tapered off once the mother is happy with her
milk supply, or in the case of your patient, her
anxiety has dropped sufficiently for her let-down
to work normally. If your patient was my client
and I was still working in Zimbabwe, I'd suggest
she go and see her GP, OB or paediatrician to
discuss the adviseability of a course of
sulpiride (50 mg 3 times a day) and I'd know that
within hours she'd be taking it and be starting
to feel some relief in what must be a really really difficult situation.
If you'd like a copy of the handout I developed
(which demonstrates how commonly this drug was used....) just let me know
Warm regards, and happy World Breastfeeding Week to all
Pamela Morrison IBCLC
-----------------------------------------------------------
Date: Thu, 31 Jul 2014 10:19:20 +0200
From: Carmela Baeza <[log in to unmask]>
Subject: Supressed/very delayed letdown reflex
Hi all,
I am working with a mom in a hard spot: she has a very ill, hospitalized 1
month old (cardiac surgery at birth and many complications from then on)
whom she is pumping her milk for. At home, she has a three year old child
with autism. She and her husband have very little support from family and
friends, because the mom is terrified of her baby gettiing any kind of
infection - she does not let anyone help her with the older child so as not
to expose him to germs that he then might pass on to her and she to her
hospitalized baby.
So she and har husband are taking 12 hours turns, in which one of them is
at home with the older child and the other is at the hospital with baby. Of
course, the older child is reacting strongly to the whole situation.
And she´s trying to mantain a milk supply (plus eating a few meals, getting
some sleep - you know). Support for breastfeeding and kangaroo care at the
hospital is disastrous.
The main pumping issue with her is that when she starts pumping it takes
12-14 minutes for the milk to START flowing. Once it starts she gets good
amounts (80-100 ml from each breast). We have tried hands on pumping, we´ve
got the right size flange and a good pump. She breastfeed her first child
for a year and a half with no problems.
My guess is that, with her exhaustion and high-stress situation she just
does not make enough oxytocin to have let downs... can this be? And I don´t
know how to help her more, we are in touch constantly by phone, I am giving
all the emotional support I can, her husband is great - they are just not
weeing each other because of the shifts. It´s just such a difficult
situation all around.
Any ideas?
Warmly,
Kika
--
Dra. Carmela Baeza
Médico de Familia
Consultora Certificada en Lactancia Materna IBCLC
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