I've been working with a young mom since her baby was 3 days old (now approx. 4 weeks old). Baby was born at 37wks 2da, had latched on only once in-hosp, went home finger-feeding. He looked jaundiced (surprise, surprise!), and when parents took him to ped later that day, he was re-admitted to hosp to go under bili-lights. Through all of this mom was pumping like crazy, trying to bring in her milk supply, but never pumped more than a tiny amount. Baby had a tight frenulum, clipped on day 9. He stayed on better after clipping, but still could not get him to do more than 5-7 minutes at a feeding. Parents switched to a bottle because finger-feeding was so slow, and kept offering him the breast, followed by a bottle (I know, I know). But that was what they felt they could do at that point.
Meanwhile, she's getting nothing or a few drops when she pumps. I asked her about any vaginal bleeding (at 2 weeks). Mom said she was bleeding during the first week, but that cleared to a grayish, clear discharge. At 1 week PP, she began to bleed heavily (more than her menstrual bleeding had ever been pre-pregnancy). She had called the hospital where the baby was born, and she was told by "someone" that she just had her period!!! I suspected the combination of low milk output and heavy bleeding points to a retained placental fragment, advised her to call her HCP ASAP.
Her Ob's nurse told her that it didn't sound like a retained placenta, and to just keep pumping (aargh!). I recommended that she ask for a prolactin level, and begrudgingly, they did it. Her level was 5.3ng/ml!!
The nurse in the OB's office told her that since they don't routinely do prolactin levels, "nobody" in the office is sure what that means. I gave her Ruth Lawrence's table of normal prolactin levels to show the HCP. I feel like I'm beating my head against a brick wall here. Any advice from wiser heads would be greatly appreciated. TIA.
Beth Sargent, IBCLC
Needham, MA, USA
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