Here's a mystery for Lactnet brains

I'm working with a mother who gave birth to twin sons 12 days ago. No
problems during pregnancy, normal breast enlargement, healthy mother. Had
normal vaginal delivery, no
drugs. Pregnancy weight gain was 45 pounds, babies' birth weights were 7.9
and 7.5 pounds. Skin-to-skin after delivery, no problems latching or
suckling. This mother has 3 & 6 year old daughters, breastfed each for one
month without problems, good milk supply (quit because she went back to
work).

Day 4: Boys had been breastfeeding Q 2-5 hours since birth. Both slightly
jaundiced, "sleepy" (were falling asleep after about 5 min at breast),
voiding OK, decreased stooling. Each baby had lost >1 pound. Mother says
her "milk is not in" (Sorry Kathy A-I did correct her at this point). She
was told to supplement & over the next few days continued to BF and
supplement until babies' weights increased.

Day 9: Still no increased milk production. I spent several hours with her
massaging, compressing, latching babies on & off, and finally pumping with
compression and massage. At breast: infrequent audible swallows, pumped
<5cc (which we divided between the boys &they loved it). She described her
lochia as bright red and "pretty steady". I thought "Ah Ha! Retained
placental tissue...." So, she was going to BF with SNS and/ or
continue with breast stim and call her OB. Later that night, she
spiked a temp of 101-102 & had chills.

Day 10: OB palpated several abdominal massed so ordered a CT scan. Result/
diagnosis: Thecalutean Cysts. OB says she has several large ovarian cysts
which she thinks are secreting estrogen, thus suppressing milk production.
She thinks they will shrink in about 6 weeks and expects milk production
will increased when that happens. In the meantime...........:-(

The only definition I can find is for "Theca Cell Tumor": an uncommon,
benign fibroid tumor of the ovary, composed of theca cells & usually
containing granulosa (follicular) cells, frequently associated with
excessive estrogen production & tend to develop cystic degeneration. Also
called fibroma thecocellulare xanthimatodes, thecoma.

Have any of you ever heard of or seen anything like this? Her OB says she
has never seen this either. She is very pro BF & we're both most anxious
to learn of anything that will help this mom.

We're looking forward to your responses!



Amy Mueller, BSN, RN, IBCLC
Traverse City
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