Hello!


I would appreciate input in this case. A mother (permission to post)
contacted me a couple of weeks ago to discuss with her options. I have not
seen the mother, she called me via volunteer peer support telephone line. My
phone number was given to her by a peer counsellor. Since this is volunteer
bf support, I did not took complete medical history. According to mother,
she did not have any history of medical diagnoses or anything unusual during
the pregnancy, no medications. First baby, 3 months old, exclusive
breastfeeding then. The mother wanted to talk about her options how to stop
breastfeeding safely in her situtation. She got some kind on infection in
stomach area in a week after birth (unknown focus) and CRP got high, so it
was treated with iv-antibiotics. After the first infection, she got a couple
of episodes intense stomach pain and high CRP and was diagnosed clostridium
difficile colitis. Cl Dif was treated with iv-antibiotics and the mother got
rid of it after all. The mother also has a history of plugged ducts and
mastitis which turned a couple of times to infection and needed antibiotics
to resolve according to the mother. When she called me three weeks ago, we
talked about continuing breastfeeding and managing plugged ducts (lesitin,
latch and the conservative treatment  etc.). But mainly the mother wanted to
know, how to cut down supply and weaning as quickly as possible without
getting plugged duct and infection. I told her about herbs (peppermint and
sage), management of over-supply and medications which lessens milk amount
(oral contraceptives) and cabergoline (Dostinex). The mother already had the
prescription of bromocriptine, but had not took it after reading the
information about it. I told that it is not recommended any more. I praised
her being so brave to keep on breastfeeding despite all the difficulties in
the first months. I told her, that usually the plugged ducts would stop at
some point even if she did not get to know why she got them. But I also told
that if she decides, it is ok to stop breastfeeding.

I asked the mother to tell me later, if she wish, what she desided and how
the breastfeeding continued / the weaning went, as I tell every mother who
calls me. A couple of days ago I got a SMS and she told, she had taken
Dostinex monday this week. She was too afraid to continue bf with the fear
of another pluggeg duct/infection and the fear of recurrent Cl Diff. She was
told by the MD probably, that she needs only to pump to relieve discomfort
and the milk would dissappear from the breasts after Dostinex. I wish she
would have asked before she took the medication, since I would have expected
more pumping needed until the effect of medicine will start and would have
told her different advice. I answered to pump more often to keep breasts
health (she did have lumps then) and got SMS today. She got plugged ducts
and painful, red areas to her both breasts and high fever and infection. She
is on oral antibiotic treatment again. She is pumping now regularly to heal
the breasts and get about 15 ml / pumping from one breast and almost nothing
from the worse breast. The ultrasound is going to be done shortly to rule
out abscesses. I encouradged her to pump every couple of hours during
daytime and do other mastitis treatment until the breasts are healed. After
that she could shorten pumping sessions and gradually lessen them until
zero. She will take the other doses of cabergoline in a couple of days. I
would expect the full effect of medicine start to be seen soon.

I have experience about this medicine when the mothers have used it early
postpartum period (and therefore had little milk prior taking it) and were
trying to get milk supply back after reconsidering. Does any one of you have
experience with the mothers who had taken it later and with good milk
supply. How long it took for the milk supply to diminish and the need for
pumping stop?

Thankyou in advance!
Best wishes,
Pia Ruohotie, RN (Special Care Nursery ward) and breastfeeding counsellor
from Helsinki, Finland
Helsinki University Central Hospital, Jorvi Hospital

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