This is really sad, Debbie. Makes me wonder why the spot on my wall isn't
bigger from all the head banging. Kathleen
At 07:10 AM 05/08/2002 -0400, you wrote:
>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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Kathleen B. Bruce, BSN, IBCLC co-owner Lactnet, Indep. Consultant
http://together.net/~kbruce/kbbspin.html
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