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Subject:
From:
Cathy Fetherston <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Tue, 12 Feb 2002 16:12:39 +0800
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>    Good grief, so prolactin levels can be normal and yet there be no
> lactogenesis II? I have a mom dealing with that now. First look is to see if
> all the placenta is out, then check thyroid.
>    If those indicators (sodium, citrate, lactose and total protein) show
> failure in lactogenesis, is there any clue why?
> Which comes first? >What keeps the switch from being turned on?

Could be a myriad of different things (including all the ones we haven't
thought of yet) - a real challenge to us all. Things that quickly come to
mind:

With pre term mums  - is the administration of betamethasone prior to
delivery. There has been work done on sheep (I think it was sheep) that
shows it stimulates initiation of lactation (when given during pregnancy)
which is then followed by a delay or failure to initiate after birth. A  new
PhD student (and midwife) is going to look at this influence in women
delivering pre term who receive betamethasone to stimulate the maturation of
their babies lungs - which should be really interesting.

We could also perhaps consider any hormones that mimic actions of PIF
(prolactin inhibing factor) which is closely associated with dopamine. (in
fact metoclopramide (reglan) works by inhibiting hypothalmic PIF secretion
through dopamine antagonism). Although prolactin levels are within normal
range they may effect the binding capacity and receptor responsiveness.

Also Prostaglandin E & F2 alpha inhibit prolactin (as do ergots) so prostins
(E) inductions and ergometrine administration for PPH (or syntometrine for
3rd stage) may have some influence (a couple of studies are quoted by Hale
but only about oral ergots given in the first week post partum).

Cathy Fetherston
Perth Western Australia

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