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

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