I've been working with a mom over the phone who lives a distance from here
and hasn't gotten anywhere locally. Her baby is now 5 wks old; we talked
first about 2.5 weeks ago. Bottom line is that her milk virtually didn't
come in. Her overall health history is clean, but she had placenta accretia
and hemorrhaged pretty badly in hospital, requiring a couple of units of
replacement blood. Her hemoglobin dropped to something around 5 at one
point.
Mom had been pumping and taking fenugreek, to no avail. She also tried
Reglan, with no real changes. I suggested she go back to her OB office and
request some blood tests-- TSH and prolactin. Her CNM decided to go with
prolactin and cortisol instead. Blood was drawn 20-30 min after pumping for
15 minutes, at 30 days pp. Prolactin was 13, cortisol 17. The OB office
conferred with an endocrinologist, who told them that her levels were
"normal". Sigh.
I don't know the significance of cortisol, but according to Lawrence the
prolactin should have been 60-110 at *baseline*, let alone after
stimulation. We don't have Sheehan's, but there seems to have been an
insult. Mom continues to pump every 3-4 hours, gets 1-2 tablespoons of milk
per breast first thing in the morning, then maybe a scant teaspoon each side
thereafter. Baby will go to breast but promptly falls asleep, and mom has
not been interested in SNS.
One other interesting item: a lay midwife asked this mom if she knew what
drugs she was given for the hemorrhage, saying that if it was "hemabate", it
could suppress lactation. Mom is going to try and find out what meds she was
given; I did not find any such drug listed in Hale to double check.
The only possibilities I see left, besides continuing to build iron in her
diet, is possibly domperidone. I don't know how much that can help, but
that's all that I know of left. Comments? Ideas?
~Lisa Marasco, BA, IBCLC
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