I have a somewhat related situation.  I'm working with a first time mother
who had a pituitary adenoma a couple of years ago and for quite a while she
was on a med to reduce her prolactin levels.  She states that she stopped
taking it early in the pregnancy, but other things she has said make me
wonder if this is so.  In any case, she is almost 3 weeks postpartum and
getting less than 1 oz when she pumps.  Her baby will not latch properly
with mother and transfers very little.  We know the little one can
breastfeed since he breastfed quite well from his aunt who is nursing his 9
month old cousin.  I've assessed a feeding and he latches well with good
suck/swallow/breathe ratio for 1-2 minutes then no matter how he is
positioned, he pulls his tongue back and starts pinching the nipple.  He
doesn't do this with his aunt.  His mother's nipples are quite large (almost
quarter size) and we suspect that may have something to do with it... his
aunt has dime sized nipples.  So we're thinking maybe tincture of time...
But in the meantime mom is not producing enough milk.  Her sister is trying
to help out by pumping as well, but she also has her baby to think about and
they finally had to give the baby formula last week (after he was
hospitalized for jaundice).

Questions:
1)  Could taking the Cabergoline (Dostinex) have caused her breasts not to
form enough breast tissue early in pregnancy?  She states she did not
increase in size during pregnancy and minimally since birth.
2)  She does not believe that her endocrinologists will want her to increase
her prolactin levels (and she is hesitant as well since she states the
increased 'sky high' prolactin levels caused the tumor).  So where does that
leave us for trying to increase her milk supply?

We have tried several different pumps -- Medela classic, lactina,
Whittlestone.  No difference.  I've given her pumping tips and watched her
pump.  She is pumping around 10 times a day.  She is doing the routine where
she pumps until the stream slows to drops and then stopping and massaging
her breasts and then putting the flanges to the breast again until the
stream slows and so on for 15 minutes or so total.  She seems to get more
milk this way, but still nowhere near what she needs for her baby.  Any
other ideas?

3)  Can we assume that if she hasn't a good supply by this point and can't
take herbs or meds to help increase it, and is pumping to best effect now,
that she just will not be able to get a good supply?  Her sister and I have
both discussed the SNS with her and perhaps just feeding the baby that way.
Maybe skipping the pumping but doing all feeding at the breast.  She hasn't
gotten back to me on that one.

Anyway, if anyone can think of something I'm missing that we could do, I'd
appreciate it.

Regards,
Cindi Swisher, RN, IBCLC

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