Looking for info on pp hemorrage & lactation

BrewerRN · Jun 1, 2010

Hi,

I am a RN and IBCLC (International Board Certified Lactation Consultant). There is a possibility of a problem called Sheehan's Syndrome. With this syndrome there is a possibility of delayed or absent lactogenesis. There's a great website:

http://www.mayoclinic.com/health/sheehans-syndrome/ds00889

symmetry · Jun 1, 2010

A severe PP hemorrhage can cause Sheehan Syndrome where decreased blood flow to the pituitary gland may affect prolactin production, suppressing lactation. A mild case of Sheehan Syndrome can cause a delay in milk production. In this case, frequent breastfeeding or pumping can stimulate the number and sensitivity of prolactin receptors to take advantage of the small amount of prolactin available.

There is research suggesting that adequate amounts of milk can be produced among mothers with varying levels of prolactin and that the body's autocrine control of milk production may be able to compensate for a hormonal environment that is less than optimal.

I would encourage your patient to breastfeed frequently and watch the baby's diapers and weight, especially after being discharged. The pediatrician should be alerted to Mom's hemorrhage situation so they'll be aware to watch the baby more closely for inadequate weight gain.

lactnet · Jun 1, 2010

You can refer her to her local La Leche League leader who may have more time to work with her once she is home.

Also this website is extremely helpful:

kellymom :: Breastfeeding and Parenting

And at ask Lenore she can find info on pharmaceuticals that help boost supply such as Reglan

Ask Lenore ~ Home Page

Elvish, BSN, DNP, RN, NP · Jun 1, 2010

I have taken care of a mom with Sheehan's syndrome (pituitary necrosis confirmed radiologically). Her EBL was something like 2500 after a vag delivery.

I am really cautious about telling moms that they won't make milk after a big EBL; not because it can't be true, but you have to word it very carefully. It's not helpful to anyone if Mom is worried so much about something over which she has no control. We watch the baby, watch the weight/diapers, encourage her to feed frequently, and help with breastfeeding as much as we can. Like a previous poster says, if it's Sheehan's it depends on how extensive the necrosis is whether a woman's body will respond to pumping/nursing and eventually make up for lost time, or if there just won't be any milk at all.

skybmonkey · Jun 1, 2010

I am not a nurse yet, but I did hemorrhage with my first (and only) lady partsl birth, I actually had a whole lot of complications, pre-eclampsia, ran a fever, had to have a mcRoberts, and post partum depression. Anyhow, it did take longer for my milk to come in (in comparison to other moms), but no worries because I didn't give up and I was determined to nurse. So finally after about a week, I had some rich milk and breast fed for a long time :-) Took some fenugreek (sorry forgot the names of these herbal supplements in pill form) to stimulate more milk production but not sure how that really worked. I think it was more psychological that I thought I had more milk, people were always telling me that my child was crying because she was hungry and I wasn't making enough milk. Never again will I let anyone feed me that nonsense. Just support her if she is interested in breastfeeding and encourage her. Tell me her my story if you wish. :-)

heatheryk · Jun 2, 2010

a friend of mine recieved 27 units of blood after a pp hemorrhage & then hystorectomy. She was able to breastfeed.

klone, MSN, RN · Jun 2, 2010

The important thing for this mom to know is that ANYONE (unless she has no breasts) can breastfeed. How much milk she can produce on her own, she will only know in time, but even if she can only produce a fraction of the milk the baby needs, she can still exclusively breastfeed (with a nursing supplementer/lactation aid).

akmama75 · Jun 2, 2010

thank you all so much for the quick responses to my question! The pt is still here so I will share all of this info with her. What an amazing resource this website is! Thanks again!:redbeathe

SmilingBluEyes · Jun 2, 2010

I agree with having her follow up with LLL (la lache league) after d/c. They are a wonderful resource. I have seen many a person with pp hemorrhage be able to breastfeed!

Marymoomoo · Jul 13, 2010

I know this is an old post but just want to chime in and say that in a case like this, it would be all the more important to keep mother in baby together as much as possible and encourage sustained skin to skin contact if at all possible. Early physical contact is very important to both long term breastfeeding success and bonding.

You would want to assure that the mother was educated about what to look for as far as signs of milk intake in baby (including suck:swallow:breathe patterns, relaxed hands, diaper output), she has a follow up visit scheduled within days after discharge, and she has the number for community resources (LLL, WIC Peer Counselors, etc). Let her know when to call the doctor or lactation clinic, and be sure that someone follows up with her.

Asides from skin to skin contact and facilitating breastfeeding, the other important thing to do is empower the mother and build her self confidence. Don't forget to talk to the father or the mother's partner, too. Assure they know what a good latch looks like, how to tell baby is getting enough, and what to do to help the mother.

A great support system for mothers who are unable to provide their babies with enough milk is MOBI:

MOBI Motherhood International

An excellent book for professionals and mothers alike is The Breastfeeding Mother's Guide to Making More Milk seen here:

Amazon.com: The Breastfeeding Mothers Guide to Making More Milk: Foreword by Martha Sears, RN (Breastfeeding Mothers Guide) (9780071598576): Diana West, Lisa Marasco: Books