I am on the trail of insufficient breastmilk production as a result of
retained placental fragments again.  Looking up my notes I see that I wrote
to Lactnetters about this, asking about prolactin levels, at the end of
2000.  However, I realize that I was asking about the wrong hormone; now I
am seeking information about progesterone levels.

Yesterday I spent a long time with a mother whose little boy has not
regained his birth weight by three weeks of age in spite of all her
considerable best efforts to exclusively breastfeed him.  She continues to
pass gushes of blood every few days, with clots, and I suspect retained
placenta.  So I gathered up my courage this morning and phoned the OB,
speaking to the sister, and the OB himself, about this gallant mother in
particular, and going on to describe the how I suspect that this is a cause
generally of low breastmilk production in a fair few mothers that I see.  He
will see the current mom.  But I asked him if it would be possible to do a
blood test to ascertain progesterone levels to rule out retained placenta if
I see future patients with unexplained low milk supply. To my surprise he
agreed, suggesting that we test the next 5 - 6 of his patients in whom I
suspect retained placenta this might be the cause of delayed/reduced
lactogenesis II, and take it from there!

Now I want to write to him with some background, quoting Riordan & Auerbach,
and Lawrence, Neifert, and possibly Hartmann and Biancuzzo.  However, what I
really need is some numbers;  what would be the normal blood progesterone
levels for a woman in the early postpartum who has no retained placenta, and
for whom Lactogenesis II has commenced in the normal way 36 - 72 hours after
birth?  I also have the May 2001 JHL which contains Ann Anderson's piece on
disruption of lactogenesis by retained placental fragment. This article
mentions HCG. Should I suggest that the OB could look at blood levels of
other hormones?  Does anyone have any advice for me?  I have the feeling
that I have one bite at the cherry, and want to get it right first time! I
want to give helpful information, refs, and so on, when I write to confirm
our conversation in the next day or so.  I'm also thinking of building on
this success, and making asking some of the other OBs too.

Many thanks for any and all advice.

Pamela Morrison IBCLC
Private practice, Harare, Zimbabwe
email:[log in to unmask]

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