In a message dated 99-11-20 14:08:54 EST, you write:
<< I had two phone calls yesterday from women who's OB's wanted them on
estrogen replacement. The first one has been told that due to the low
estrogen
associated with breastfeeding, her vagina is dry, and in a menopausal state.
It has been recommended to her NOT to stop nursing but to take the estrogen
replacement. This mom's real question to me was how to get her milk supply
back up since it was down before she went to the OB, then she didn't nurse
for 24 hours while deciding what to do. Her baby is 6 weeks old and she
nursed 3 other children besides this. I guess she is just miserable with
this very sore vagina and I wanted to know if any of you has run into this
before, and what was done? >>
There seem to be pieces missing from this mother's story. For starters, what
would cause her to stop bfdg for 24 hours while trying to decide what to do?
Is the dryness causing her constant pain or is it with certain activities,
e.g. with intercourse? If with intercourse, she must be having quite a bit of
vag actitivity--a bit unusual for most women at 6 weeks postpartum caring for
4 children but certainly possible?? Considering the extreme response she
seems to be having, is everyone certain it is dryness causing the problem and
not some undetected birth-related injury to the perineal/vag tissue? What
form of estrogen replacement has been suggested? Even if a vag creme was
suggested, I would think significant amounts could be absorbed into systemic
circulation via the vag mucosa and then affect production if used
frequently--but maybe if for occasional use only, it would have less effect
on production. (And if not already given the old college try, I vote with the
rec for KY jelly as an initial intervention...)
As far as getting supply back up, if her baby has been an effective
breastfeeder til this episode, I'd suggest taking baby to bed or sofa for
24-48 hours of round-the-clock breastfeeding.
<< The other mother is having PPD and has been crying for a week. The DR
offered her birth control pills which she was very hesitant to try and
didn't. Which seems to work better, the birthcontrol pills which may inhibit
her milk supply, or putting her on an antidepressant and talking to a
counselor? >>
What makes the doc think BCPs will decrease the depression? A review of the
lit indicates some have hypothesized that low estrogen levels related to
lactation in the early months may be associated with increased PPD, but the
research evidence simply doesn't support this hypothesis. I'd suggest
assessment by a psychotherapist, psychiatrist or clinical
psychologist--especially one whose practice focuses on helping women. Other
good sources of info/referral include:
1. Depression After Delivery, Inc., PO Box 1282, Morrisville, PA 19067;
phone: 800/944-4773 (information request line) or 215/295-3994 (professional
inquiries); web site: www.behavenet.com/dadinc/
2. Postpartum Support International (postpartum depression or anxiety
disorder information), 927 N. Kellogg Avenue, Santa Barbara, CA 93111; phone:
805/967-7636; email: [log in to unmask]; web site:
www.iup.edu/an/postpartum/postpart.htmlx
Good luck.
Karen
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