Kathleen,

There's a good description of Sheehan's syndrome in Lawrence, pp 498-499.

I worked with a 42 year old first time mother last year who consulted me
because of latch on difficulty and no milk on day 6.  History revealed she
required 2 units of blood after a difficult forceps delivery (baby 9.4 and 16
days overdue) during which her placenta broke up, and her uterus turned
inside out. Horror story, right ?   She received two doses of Prostin
(methergine) immediately after delivery to control the bleeding. MD confirmed
that no placental fragments were retained.

Her milk did not come in, in the sense of feeling engorgement, until day 35.
Meantime she pumped, sometimes used SNS at breast, sometimes finger fed and a
lot of the time bottle fed. Baby was marvelous - accepted all modes of
feeding.

 This mother had a history of depression, treated with meds. since age 22,
most recently Pamelor which she discontinued a few months prior to pregnancy.
While she was determined to  breastfeed this her first and only child, she
was also struggling with post partum depression and fact that her mother was
dying of cancer.  Her efforts to bring in milk were therefore sporadic.
 Pumping was erratic - anything from 2 to 5 times daily, and some days not at
all. I encouraged anything she could manage.  For the first 10 days or so she
pumped small amounts of colostrum only - one teaspoon per day. In the third
week, colostrum had a white tinge and increased slightly in amount. On Day
25, pumping 3 times, she produced one and a half ounces per pumping.  On Day
35, she called in excitement to announce that her left breast was engorged,
and she saw milk in the baby's mouth after nursing. Milk came in to the right
breast a day or so later.

Gradually use of SNS etc was discontinued and mother was fully breastfeeding
with occasional bottle supplements. She attended my support group so I was
able to observe her nursing twice a month until baby weaned at eight months.

What I learned from all of this - never give up hope !  I was intrigued with
this case, inspired by this mother, and awed by the fact that even with all
the complications, nature triumphed.

Beverley Rae, MSW CSW IBCLC
Manhasset, NY, still feeling the glow