I have permission to post from a mom who delivered her first baby, a healthy girl at term, 7 weeks ago by caesarean after a long hard labour. She has been unable to produce more than drops of milk in this time, has been seen by a local breastfeeding physician and a practicing IBCLC (I am non-practicing), and has been told that she has an extremely low prolactin level of 1 mcg/L, normal for lactating women being 75 to 400 mcg/L, and that this is the probable reason why she has not been able to produce much milk. She has an appointment to see an endocrinologist in about two weeks time. Interestingly, she experienced breast changes in pregnancy and leaked colostrum from 26 weeks. She was easily able to express colostrum in the first few days after birth as well. Things went downhill from there, but mom sought expert assistance within the first week and was pumping with a good double pump by the second. She was also prescribed domperidone and took unspecified herbs to increase milk production. None of these measures produced more than drops of milk or transfer of milk to baby, and mom pumped only occasionally after the second week. The baby's latch was assessed to be excellent and in fact she nursed like a pro in the recovery room, so there is no thought that the problem is due to factors in the baby. Mom very much assumed she would be breastfeeding this little girl and is naturally very sad about this. Baby has continued to take ABM exclusively at the breast with an SNS except for an occasional bottle (not daily). The mother is hypothyroid, but has been taking Synthroid for some time, and did require an increase in dosage postpartum. She says that aside from the usual postpartum fatigue, she really feels quite well. She has had numerous blood tests, including HCG and cortisol levels, which were normal. The prolactin was the only abnormal result. To her knowledge, she did not hemorrhage after the birth, nor was she given an ergot preparation. She has no family history of severe lactation difficulties, although her own mother felt she needed to ensure she had plenty of rest, food, drink, etc., to keep her supply up. Conception took about two years to achieve, but mom and dad had frequent separations due to work during that time, so it is difficult to say if she had any difficulty becoming pregnant; she did however become pregnant through natural means. She has not been told she has PCOS (polycystic ovarian syndrome), so she doesn't know if that is being considered as a cause. Retained placenta has been ruled out -- I think. Is the presence of a normal HCG definitive? Her pattern of lochia has been slightly unusual. It did not taper off until 5 weeks, then during the 6th week she had quite heavy bleeding for two to three days, enough to prompt a call to her physician. That resolved, and now at 7 weeks, the lochia has now almost tapered to nothing again. There has been no noticeable increase in milk production since that heavy bleeding. She has not had an ultrasound postpartum. Mom would like to make sure she has done everything possible to produce breastmilk for this baby. She asked her physician about taking supplemental prolactin, and the physician apparently told her she had not heard of this being done. She called me to see if I could dig up any more information on this for her. My online research indicates that prolactin, synthetic or otherwise, is probably only available experimentally. I would like to know from LACTnetters if they have heard of or know of women taking prolactin to correct a deficiency. Are there researchers out there that this mom could be in contact with? Might this be undiagnosed PCOS? I know that there has been discussion here recently re: using metformin to augment milk production for women with PCOS. If this is the problem, how much longer might it take to diagnose? Time is of course ticking away for mom and baby, and she would understandably want to try any new course of treatment as soon as possible. For the clinicians out there, have you seen a situation like this improve in a subsequent pregnancy/after another birth? My reading seems to indicate that the hormonal milieu, even when out of whack in certain respects, is not static and may improve with the next pregnancy, for example. I am confused by the presence of colostrum, which was not followed by significant milk production. Is the presence of colostrum a hopeful sign for any future babies, if not this one? Should other galactogogues be tried? Thank you for any and all comments and advice. Mom is most interested in knowing about the possibility of supplemental prolactin. Barb Strange *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html