Marie

Your post about prolactin levels and prolactin receptor sites within the
breast was tremendously helpful to me. I would like to use it in order to
educate myself and then to initiate a discussion with one of our local
obstetricians about delayed or absent lactogenesis II as a result of what I
suspect, but cannot prove, is due to retained placental fragments.  It seems
to me that the current methods of investigating this possibility in this
part of the world are a bit hazy; the OB performs a physical exam, and may
order an ultrasound scan, which may or may not show retained products of
conception (usually it doesn't) and may feel offended at the (unfounded)
suggestion that he may not have properly completed the delivery of the
placenta.  If the milk still doesn't "come in" adequately, and if the mother
goes on passing blood clots, or experiencing heavy bleeding, I would like to
know if it would be possible to do a blood prolactin test, and if measurable
prolactin levels could be obtained that would warrant further investigation.

I also occasionally see mothers who have started a progestin containing
mini-pill, and whose babies show overt or covert signs of "not enough milk"
(fussy, overly-needy, reduced urine/stool output, sometimes actual low or
static weight gain).  I would like to know if prolactin levels could be
measured in these mothers to demonstrate that the hormonal contraceptive is
having a detrimental effect.  But what levels are normal?

The prolactin levels you quote in your post are very helpful.   You mention
"200-400 ng/mL at term". This is just before labour begins?  Do the levels
increase beyond this within the first 36 - 72 hours after birth, or is this
the normal figure we should see if Lactogenesis II is proceeding normally,
ie if progesterone from retained placenta is not inhibiting prolactin release?

Are the numbers behind the references to Riordan and Auerbach, and Lawrence
and Lawrence which you quoted *page* numbers??  If so, which editions??  If
not, please could you quote the full refs?  The OB I would like to discuss
this with is very picky and exact - I need to be quite, quite clear on my
facts before I open this up for debate!  Thanks.

One last thing - if anyone else currently uses blood prolactin levels as a
diagnostic tool, either for retained placenta, or to provide evidence that
Depo or a progestin-containing oral contraceptive is hindering lactation,
please share.  I guess I'm looking for proof that these things *do* have an
effect on breastmilk production, so that obstetricians will take them
seriously.  Thanks for educating me and for any research/ideas anyone can share.

Pamela Morrison IBCLC, Zimbabwe.

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