Barbara writes:

<Today a 24-hr postpartum patient told me>
<Today we could not express a drop of colostrum.  In addition, her baby
could not
latch onto her flat and retracting nipples.>

Did she by chance have a long pitocin induction? Or augmentation? This is
mighty soon for edema/nipple flattening etc. even if just 500-1000cc. or
so of IV fluid (without pitocin) was infused possibly because of an
epidural.

I have no expertise in the matter of prolactinomas. But even though
there's a "zebra" to be seen on the horizon, it might be wise to consider
that the "hoofbeats" you hear might partly be coming from "iatrogenic
horses" in the underbrush, to mix a metaphor or two.

Oxytocin has some anti-diuretic qualities. It also shares a few chemical
similarities with ADH, probably causing some competition for binding
sites when exogenous pitocin gets administered.

On top of that, even though those two hormones come from a different lobe
than prolactin, still, if there's already a problem with the pituitary,
sudden discontinuation of medication that had been keeping one pituitary
secretion in check, might theoretically have some sort of rebound effect
on other secretions (????)

I think Reverse Pressure Softening is a good bet to teach this mother.

Denise Fisher has been kind enough to put the RPS intervention up on
http://www.BreastEd.com.au

Jean
***********
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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