Well, friends, once again I have moms all over our unit who have had PIH and were on Mag SO4 for 3-4 days.  These moms seem to have a pitsy problem with low or no supply.

One mom in particular - I'm going to need ya'lls help with!!  She has a history of severe psychosis.  Has not been on any meds because she wanted to get pregnant and breastfeed and thought it would be best not to take medication.  That's another story.  My problem - breastfeeding is THE MOST IMPORTANT thing in her life right now - her baby was born at 24 weeks gestation and is on high frequency ventilation - long road ahead!!   This mother will sit in my office and boo hoo and beg me to tell her that she will get milk.  Her baby is now  about 7-8 days old.  This mother is lucky to get a few droplets when she pumps.  Manual expression gives nothing.  
I am very concerned about her supply and  she is doing everything she can - fenugreek, pumping ever 2-3 hours, massage, looking at pictures of baby, etc.  I've done therapeutic touch a few times as well.  Even more concerning to me is her mental state - I am truly worried that she will "go on over the edge" if she cannot produce milk.   She even stated to me that if she cannot produce milk she might as well take her baby off the ventilator and let her die!!  We are talking serious stuff here.  I have tried to reassure her that she can experience a significant delay in milk production after PIH and Mag SO4, but I'm afraid that her agitation will play an even larger role in poor production.  She does see a therapist on a regular basis - thank God!!
What me do, what me do??

Dani Hudspeth RN, BSN, IBCLC
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