Salaams, all

To Kathleen Bruce, Kathleen Auerbach, Patricia Drazin, Lynn in South Africa,
Lisa in California, Maureen in Australia and Leslie in Canada - thank you
for your welcome and info.  LACTNET is simply the best - I think I'm
becoming addicted ....

I have a new client who is planning to adopt a newborn in mid - end July.
The baby will be MINUTES old and she would like to put the baby to the
breast immediately (isn't it just the greatest?).  She experienced puberty,
menstruated at 15, experienced hot flushes at 17, became menopausal at 2O
and had her ovaries removed 9 years ago at 21.  She became pregnant as a
result of GIFT fertilization 5 years ago and miscarried twins at 8 weeks.
During this pregnancy she experienced very noticeable breast tenderness.
She has an underactive thyroid, takes Eltroxin for this and a recent test
showed thyroid levels to be normal. She takes Logynon ED daily as a hormone
replacement therapy (this is 6 tablets Levonorestrel 0.05 mg,
ethinylestradio 0.03mg; 5 tablets Levonorgestrel 0.075mg, ethinylestradiol
0.04mg; 10 tablets levonorestrel 0.125mg, ethinylestradiol 0.03 mg; 7
placebo tablets).  Her gynaecologist has prescribed sulpiride 5O mg three
times daily to assist with breastmilk production (this is the most common
galactogogue used in Zimbabwe, 27% of all mothers I saw in my first year of
practice had been prescribed this medication at SOME point in their
lactation careers!)  Her breasts are small, but a "normal" rounded shape
(not that conical hypoplastic shape associated with inadequate glandular
tissue), the areolae are small, nipples normally protruberant, "average"
size and shape.  This client REALLY wants to breastfeed. I have recommended
breast massage and stimulation/manual expression 7 - 8 times daily to induce
lactation and we have reviewed the likely need for supplements, how they
will be given, how to monitor the baby's urine/stool output and weight gain
etc.

I would be VERY grateful for the benefit of your opinion on the hormonal
implications for this adoptive mother.  The same gynaecologist prescribed
Estraderm patches 5O mcg/d (2/week for 4 weeks) to head off postpartum
depression last year for another client breastfeeding her third baby and I
am convinced that this affected the baby's weight gain.  The quantity of
milk did not appear to be affected because of the way breastmilk production
was enhanced by maximum drainage, but the baby gained weight at three times
the rate once she stopped the patches. Estrogen appears to depress prolactin
levels, but do prolactin levels exert an influence on protein content of
breastmilk? Does my new client NEED estrogen therapy and if so what dosage
would both benefit the mother and least affect lactation?  I am not familiar
with metoclopramide or chlorpromazine to enhance breastmilk production
whereas I am (VERY) familiar with sulpiride and it DOES seem to be effective
IF accompanied by frequent and efficient drainage, but your knowledge would
be very much appreciated.   Thanks, in advance, for all input.

Pamela in Zimbabwe