Dear Micky,

This sounds like it could be a really complicated case, or the loss of milk may be unrelated to the microadenoma.  You need a lot more information.

Microadenoma is a benign tumor which is usually left alone.  Depending on where exactly they are located, they can cause secretion of a variety of hormones, including, but not limited to, prolactin.  These hormones can cause a variety of symptoms, one of which can be the inappropriate production of breastmilk.  However, this production is not linked to the usual supply and demand regulation of a nursing baby.  The amounts of milk produced may be very large or very small, depending on the tumor.  Sometimes mothers also produce antibodies to the prolactin which can suppress the symptom of galactorrhea.  So the picture is not as simple as it seems - a pituitary microadenoma does not mean that a mother will always be producing large amounts of milk.

The 3-4 month period is a time when many moms feel that they are losing their milk supplies.  It may be tied to a return to work or the mom may be getting more active and not nursing the baby as frequently as before.  This is also a time when poor latch/suck may finally catch up with a baby who has been depending on the free-flowing milk supply rather than actively emptying the breast.  Mom may have underlying problems which slowly emerge after the original flush of milk dissipates and the autocrine system tries to take over.  The microadenoma may be inhibiting the ability of the breasts to maintain a milk supply adequate for the baby, even though it is causing the constant production of small amounts of milk independent of the normal lactation cycle.

Many questions:  What kind of medications/vitamins/herbs is this mom taking?  What do her breasts look like, pre and post partum?  How many times a day is the baby nursing?  How well are the babies sucking and could there be an underlying problem there, such as a tight frenulum?  Is there anything at all that the mom is doing differently at the 3 month mark?  What kind of pumps is the mom using for stimulation and are they properly fitted to her or appropriate for the task at hand?  Would the use of a supplementer at the breast be better than pumping in order to facilitate more feeds per day (in the case where baby does not want to nurse on a poorly-producing breast)?  Is the mom seeing an endrocrinologist that can evaluate and better inform her on the state of her hormone levels post-partum and how these levels may be affecting her ability to lactate?  Could reglan or domperidone be used to boost the supply (pitocin affects MER, not supply).  Is it possible that her babies simply plateau briefly at this time in their weight gain - how long did she continue with exclusive breastfeeding before it was determined that the weight issue was ongoing and not transitory?

It is usually a bad sign when a mom reports seeing multiple LCs for a problem, unless they are working together in a joint practice.  She is probably getting a lot of opinions on what is going on and what she should be doing.  She may be trying a lot of different things at once without giving any of them the time necessary to produce results or she may be trying strategies which are not really appropriate for her situation.  In the ideal world, she would be working with one competent LC who could help her to put together a strategy and a care plan which would encompass all of the variables. The LC would help her to stick with the plan and properly evaluate progress, or the lack thereof.  The shotgun approach often leads to frustration, waste of time and money and ultimately, lactation failure and weaning.  Now you are entering the picture as another voice.

It may be that this mom has a problem totally unrelated to the microadenoma which can be tackled and resolved.  Her problems may be related to the tumor ( or tumors - they can be multiple and difficult to find), but may still be surmountable with proper management.  Or she may be in a situation where supplementation may be necessary to maintain proper growth, but breastfeeding can continue in conjunction with supplementation.

 Have you been in contact with your PL department in regards to this case?  That is essential if you are going to be seeing this mom as a La Leche League Leader.  You might want to talk with the LCs involved in her case (with her permission) to get their take on the situation - it may be quite different from what you are hearing from the mom.  Use your resources to become educated about this mom's medical problem.  LLL has many resources for you - again, contact the PLD.  Good luck and keep in touch.


Warmly,
Sharon Knorr, BSMT, ASCP, IBCLC
Newark, NY (near Rochester on Lake Ontario)
mailto:[log in to unmask]

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