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Subject:
From:
Lisa Marasco IBCLC <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Thu, 2 Mar 2000 20:38:08 -0800
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I received a call from a mother of a 5 month old tonight. Everything she
told me points to a severe decrease in milk supply; baby is breastfeeding
constantly and now starting to fuss and arch her back; diaper output down;
baby is gulping supplemental bottles. She says she had tons of milk in the
early days, but the decline began at about 2.5 mos, when her periods also
resumed. Mom has two other children and had similar problems with them, but
*really* wants to breastfeed this last baby longer.

No meds, no BCPs, pretty clean health and reproductive history. I found only
two possible red flags: 1) implant 10 years ago, incision under breast,
implant on top of the chest muscles; 2) mom struggles with excessive facial
hair and has to "shave", though she otherwise is slim and "normal" looking.
Once consulted an endocrinologist for this 15 years ago.

So I'm weighing this out and thinking that either there is something
hormonal going on, or else there was areolar nerve disruption that is
preventing good stimulus to the brain and thus the proper hormones needed in
the beginning to support long-term lactation. Honestly, I would hope that
any nerve damage would have recanalized by now; had the placement been under
the chest muscle, I would probably rule out nerve damage completely.
Hormone-wise, the mom's symptoms are subtle, not flagrant.

From this vantage point, realizing that mom was breastfeeding "24 hours a
day", the only thing I see left to try is galactogogues. She started
fenugreek, 3 caps qid, but only saw a little increase. Mom has decided to
start with adding complementary herbs, and if that doesn't do it, will go up
the ladder to reglan and then maybe domperidone.

I'm wishing there was a definitive blood test. She will probably go back to
her MD and request a thyroid test; we also discussed asking to test
androgens. Thyroid would be easy but is unlikely as she is pretty high
energy; and if it's androgens, well, who knows if treating that will make a
difference?

IF there were a nerve stimulation problem, would we want to do something to
increase oxytocin along with prolactin? Does anyone see any other avenues to
chase or therapies to try?

Thanks,
Lisa Marasco, BA, IBCLC
Santa Maria, CA

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