Hi everyone!
I just received one of the most extensive emails that I ever have
received from a mother. I am NOT expecting everyone to answer this one for me.
There is no doubt that much of it will be answered by a endocrinologist. I
would just like to get opinions from those who are interested in sharing...
Debbie Albert, Ph.D., IBCLC
Tampa Lactation Counseling
Tampa, FL
Debbie,
I do have a few important questions that I was hoping you could shed some
light upon--but first I'll provide the background:
I have panhypopituitarism due to the removal of a pituitary tumor in Nov.
1999. This essentially means that my pituitary gland does not fully function, and
many of the hormones stimulated by the pituitary are no longer produced. I
have been on hormone replacement therapy for ACTH (I take cortisone) which I
continue in pregnancy. I had to replace my gonadotropins (female hormones--which
for day to day amounts to estrogen--nicely covered by oral contraceptive until
pregnancy, when pregnancy took over nicely--no replacement needed there for
the time being.) I also took Somatropin-- a type of human growth hormone
(synthetic, not bovine). I do have a portion of my pituitary that does appear to
function, however. I have not needed thyroid replacement hormone, or an
antidiuretic. My endocrinologist is optimistic that my body will produce prolactin (so
that I may breastfeed), saying it is one of the more resilient hormones.
(Phew, hope that's enough of an endocrinology lesson--tried to keep it light, and
had no idea of how much you know about that sort of thing). That being said,
here are my questions:
1) My endocrinologist feels that there will be no problem with breastfeeding
while on my replacement dose of Cortef (the hydrocortisone). I take 15
mg/day-- 10 mg in the morning, and 5 mg in the evening--- which is no more than the
normal human body produces in the same period. While I am in the hospital to
deliver, however, I will be on a standard "stress dose" of Cortisone
administered via IV. The dosing will be as follows: start of labor-- 100 mg/8hrs.
Postpartum day 1-- 100 mg/ 2x daily. Postpartum day 2 --50 mg/2x daily. Postpartum
day 3 --return to normal dose of 15 mg/ day.
Here's where I get differing opinions. My endocrinologist originally said
that there is little research to say that if I were to immediately breastfeed,
the high dose of steroids in my system would hurt the baby, since it would be
for such a short time (and it would be essentially Colostrum, since my milk
would not have come in yet anyway). He did say, however, that I could simply wait
to breastfeed until I get home from the hospital, and I'll then be on my
normal dose (and Cortisone does not remain in the system long). One of my
obstetricians (all female group practice), felt that it would be better to go ahead and
breastfeed in the hospital. I also asked my Pediatrician's office, and was
pretty much told to ask a lactation consultant. same answer by the nurse who
taught the baby-prep class). I did take a one-night breastfeeding seminar, and
the lactation consultant there had told me to call her back, that she'd read me
what she had in her book, and had numbers of people to refer me to if all else
failed. I simply haven't had a chance to call her back. I just don't want to
do anything that would hurt the baby! There is always the chance that I won't
even produce milk--but I am optimistic that I will. What is your opinion on
the subject?
2) The growth hormone (brand name Humatrope... the drug somatropin), is
optional (I don't need it to survive, unlike the cortisone). I'm not even convinced
I will definitely go back onto it after delivery. Is this something that is
passed through breast milk?
3) Is it ok to go back onto Estrogen/Progesterone replacement therapy while
breastfeeding? It sounds like my endocrinologist does not intend for me to
restart these hormones until after I stop breastfeeding-- but I have a concern
about postpartum depression (given my hormonal history), and it sounds like there
is a link between estrogen level and PP depression.
4) Final bonus "easy" question... I have inverted nipples-- and at this time,
I have begun wearing breastshells... do these really help? :-)
I realize these are not easy questions... this is why I took the opportunity
to at least put them in this email to give you a little prep-time. Any
additional information you can offer will be helpful. Thank you so much! I look
forward to talkiing with you.
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