Monday 31 March 2014

Milk Overproduction and Prolactinomas

While most moms of preemies have undersupply issues, few talk about the downfalls of having too much. I know what you're thinking - how can this mom possibly be complaining? Breastmilk is worth its weight in gold, surely there can be no such thing as too much milk... I assure you there is.

First a bit of background. One of the main reasons I have an overly active milk supply is that I have a prolactinoma. A prolactinoma is essentially a non cancerous growth that can be either teeny tiny or quite large that grows in the pituitary, a gland pretty much in the middle of your brain. Luckily mine is teeny tiny. Prolactinomas secrete prolactin, one of the hormones involved in milk production. I discovered I had a prolactinoma because one day before ever getting pregnant, I noticed a tiny amount of milk on my nipple. Upon further inspection I was able to express a couple milkly drops. One blood test later (looking at my prolactin levels), imaging of my brain (an MRI) and a visit to the endocrinologist (hormone specialist) and I was diagnosed with a prolactinoma. What does that mean for me? A yearly blood test and the occasional MRI to make sure the little bugger doesn't grow. It also means that I have an overabundant milk supply!

The last bit that they were worried about was that the extra prolactin would make getting pregnant more difficult. Luckily for us, that was not an issue!

A few hours after an semi emergency delivery of my little 29 week old darling, for my HELLP syndrome, my nurse asks me if I'm interested in breastfeeding. Still on magnesium and a bit in chock from everything that happened so quickly, I nonetheless was quite keen to give pumping a try. She brings me a pump amd explains the basics and leaves me to it. Twenty minutes later she comes back to see how I am doing, and I show her, a little disappointed, my 70mL of colostrum. She could not believe her eyes! She told me usually moms get less than 5mL on their first pump. I was pretty proud at this point, but little did I know it was a blessing and a curse.

The pros :

1) My little sweetheart luckily never ran out of breastmilk to eat. I realized how fortunate I was in that regard seeing lots of other moms in the NICU struggling and ultimately being unable to produce enough milk.

2) I was able to donate most of my stash that I had accumulated during sweet V's hospital stay to another preemie. It was all the more special that I knew how unpleasant a stay in the NICU can be, I really felt like I helped out a family in a pretty crappy and stressful time in their life.

The cons :

1) My multiple high flow let downs made teaching my sweetheart how to breastfeed more difficult that it otherwise would have been. At first, it was terrifying, she would go into fits of choking, have bradys and the desaturate. It made me feel terrible to think that I was the reason that she was choking! Still now at 10 weeks corrected age, she regularly chokes while breastfeeding, something she does not do when bottle-feeding. For a while it looked like I would not be able to breastfeed her at all!

2) At first, due to the intense let downs, miss V. had to learn how to breastfeed with a nipple shield (I used the Medela nipple shield). While it was a huge pain to have to sterilize it before every feed, it was really the only way I could get her to feed without choking. To get around having to constantly wash it, I bought 3 and sterilized them every 3 times. Having that many coupled with the 2 enriched bottles per day meant that I only had to clean them twice per day. After about 2 months, I was able to completely wean Miss V. off of the nipple shield. I guess a minor positive with the nipple shield was that while Miss V. was learning how to breastfeed, she sometimes had a bit of a shallow latch, which meant mega sore nipple for me, unless I wore the nipple shield. Lucky for me, she grew out of that bad habit too!

3) To help better control my high flow, I continue to pump off a little bit of milk prior to breastfeeding. Initally, I had to pump off 40-60mL before each nursing session. Now I only have to do that twice per day. I've tried a few times to completely eliminate the pre-pumps, however we just get right back into the chocking fest, so I guess she is just not ready yet. I use a manual pump, I find it is less of a hassle to use, and I can just quickly pump one breast prior to feeding and still hold and comfort my sweetie in a pinch. I use this one, but I'm sure any manual pump would work well.

4) Over supply means lots and lots of nipple leaking! Kangaroo care was made a bit more difficult with my very leaky nipples - I had to have 4 towels on hand to keep it in check, otherwise it looked like I had been on the losing end of a water balloon fight!

There you have it, while having an overflowing milk supply has some obvious benefits, it can also add additional difficulties when teaching a preemie how to feed, an already complicated task!

xo
C

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