Dear friends,

I have a challenging situation with a client, who has given me permission
to post for information that may help.

35yr old primigravid. with an 8 day old baby who lost more than 10% weight
by 3 days breastfeeding exclusively and expressing. Since then she has
been giving top-ups of formula and expressing with hospital grade pump
after every feed.

She had difficulty getting pregnant. A previous miscarriage at 8 weeks and
history of PCOS and prolactinoma diagnosed 4 yrs ago.

She was put on metformin for first three months of pregnancy . She noted
good breast development in pregnancy. Size 14d now.  Increase of three cup
sizes.  She has one inverted nipple , with an elastic areola and nipple
protrudes with stimulation from a breastpump.

Left  nipple is normal apart from grazing at tip  from a  poor latch
technique.

60mls can be expressed from left breast and max 10mls from side with
inverted nipple.  Baby has been feeding on left side only up to now with
poor latch.

I have got baby latching on both sides correctly and sucking well with
encouragement and use of supplementer.

My concern is around whether I can use any lactogogues like fenugreek or
Domperidone to increase milk supply if my present actions prove
insufficient given she has a prolactinoma.  I would have expected her to
have A GREAT MILK PRODUCTION, BUT SHE CLEARLY HAS NOT AT THIS POINT.  Any
experience with similar situation or research which maybe helpful. I don’t
want to stimulate growth of the tumour. Her prolactin levels were 2000
before pregnancy. I look forward to your input.



Mary Clare McCarthy

RNRM IBCLC WELLINGTON NEW ZEALAND

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