Esther
I am SO sad - and angry - to hear of the terrible tragedy that has befallen
the family of one of the Israeli LCs. They have my heartfelt sympathy. I
cannot even begin to imagine their pain.
To answer the technical question you pose, about whether to allow the
injured lactating breast to dry up - IMHO it would be much more beneficial
to keep the breast lactating, and if hand-expression is more comfortable
than pumping - then definitely to keep hand-expressing. My rationale would
be based on several aspects which maybe the doctor has not considered in
the immediate concerns of keeping this injured woman as comfortable as
possible. In many ways the situation would be like I've seen in a
post-abscess surgery, but without the complication of a pre-existing
infection. I have worked with mothers where the incision has leaked for
weeks. It can be quite messy, and leaking may occur with each
milk-ejection reflex, but it simply means that pads should be available to
catch the leaking milk, and these should be changed as frequently as
necessary to keep the skin dry and comfortable and to minimize the chance
of infection. In this case, Esther, where perhaps milk is leaking through
multiple wounds, I would not see it as a problem, in fact quite the
contrary. IMHO it would be beneficial for the wounds to be frequently
bathed in fresh breastmilk containing anti-infective and pro-healing
properties. That the milk being expressed is brown is no surprise; the
breast is damaged, the milk is bound to be sero-sanguinous.
As you mention, the milk would be beneficial for the baby, blood or no
blood (eg blood-containing milk in rusty pipe syndrome is not considered to
be harmful to a newborn). However, if the doctor wishes this milk from the
injured breast to be withheld because of concerns about the blood, or about
a post-wound infection then it could be discarded - but it would be
beneficial for the *mother* to keep the supply on this breast coming
through. At the very least I would have serious concerns about pain,
engorgement and the real risk of subsequent infection, eg mastitis or even
abscess if lactation was to be suppressed from a very injured breast by
deliberately causing it, or inadvertently allowing it to become over-full
or distended. But even if the supply were low, I would see it as being
beneficial to keep it lactating. With regard to lactation generally, the
doctor must know (or should find out) that lactation occurs independently
in breasts, as a direct result of the degree of drainage of each
breast. The unaffected breast, as well as the affected breast, will go on
producing milk for as long as each of them is being pumped/drained -
whether this is by a baby, or a pump, or by manual expression.
Concerns for the mother's on-going, emotional well-being would surely also
dictate that everything possible be done to help reduce any extra emotional
pain and distress at this time. To suppress lactation would be to reduce
her prolactin levels (artificially with medication, prematurely if the
breasts are to be "turned off" by simply not being drained). Prolactin is
the hormone we all use to help cope with stress so that reducing prolactin
levels will reduce this mother's ability to cope with her grief. If she is
being medicated with any anti-depressants to help her emotional state they
will, of course, *increase* prolactin levels - as may her grief - to
*increase* lactation.
Furthermore, the tragic loss this young woman has already suffered is
already too much to bear. She should not also be expected to lose the
expectation she had of nursing her surviving 5 month old. Whether she is
well enough to actually breastfeed her baby now or not, she may wish to in
the future, and may find solace in her ability to do so. Others have
described the comfort of being able to breastfeed a baby during a time of
great grief. Everything possible should be done so as not to deny her this
remaining opportunity.
All these rationalizations are quite apart from the one you mentioned -
that the injured *baby* should have her mother's milk if at all possible,
to enable her to recover as well as she can.
My thoughts are with this family. Please let us know of their progress.
Pamela Morrison IBCLC, Brisbane, Australia
--------------------------------------------------
Date: Fri, 22 Aug 2003 16:17:08 +0200
From: EDG <[log in to unmask]>
Subject: tragedy and breastfeeding
A few days ago there was a terrorist attack on a bus in Jerusalem. Several
babies and young children were killed and many badly injured.
Yesterday I discovered that one of the children killed was the
three-year-old granddaughter of one of our IBCLC's, Bracha Toporovich.
Bacha's 26 year-old daughter Hannah and her family were on the bus on the
way back from a family prayer outing at the Western Wall. Hanny was sitting
with her two younger children on her lap, three-year-old Tehilla, and
5-month old Shoshana. Tehilla was asleep at the time of the blast and
probably did not feel anything before she died. Shoshanna was found hours
later alive under some corpses, and is in stable condition. Hanny suffered
from a shattered pelvis, and jaw, superficial facial wounds and deep
contusions in one breast, similar to GSW's.(the explosive devices emit
thousands of bullets which penetrate all bodies in proximity.) She is
breastfeeding ,of course, and wants her baby to get her milk. The baby is
in a different hospital, and volunteers are delivering the milk to her
regularly. She was getting the milk via NG tube, and as of this afternoon
has been taken off the resuscitator, and is improving greatly ( we all know
why).
Now the breastfeeding problem: the injured breast is leaking milk. Bacha
was pumping both of Hanny's breasts, at first, but because the milk from
the injured side was brownish, decided to dry up the injured breast, and
continue to pump the healthy breast to supply milk for Shoshi. Pumping the
injured breast with an electric pump was too painful , so Bracha has been
hand expressing gently from that side only when the breast becomes
uncomfortable ( that side never did produce much milk, according to Hanny).
Now, along comes the surgeon and wants the mother to stop breastfeeding
entirely so that the wounds will heal, and won't become infected. Bracha
tried to explain that the breasts work independently, and that gradually
they will dry up the affected breast, and will continue to pump from the
healthy breast to supply milk for the baby and when possible, eventually
go back to breastfeeding form that side. The doctor insists that as long as
they are pumping from the healthy side, the injured breast will continue to
produce milk. I have references to the contrary, but this particular
surgeon will not listen. All of our breastfeeding friendly docs are out of
the country at this moment. Just as I was speaking to Bracha, I heard in
the background that a ob-gyn was on his way downstairs, and said not to stop
breastfeeding!! He will check Hanny and decide.
Have any of you had experience with open wounds and wound healing in a
lactating breast? How long can we expect it to take until the lesions close?
I will let you know what happens. It would be tragic to force this mother
who has just lost her child to stop breastfeeding, especially since the
surviving baby needs her milk to recover!!
BTW, one of the other survivors on the bus said that she was breastfeeding
her baby at the time of the blast. Both mother and baby had minor injuries.
Two other little girls gave up their seat to let a pregnant woman sit down.
The woman was killed and the little girls survived.
It has been such a sad day here.
Esther Grunis, IBCLC (who wears normal clothes in the hospital, and no
longer wears a lab coat because everyone thought I was a doctor.)
Lis Maternity Hospital
Tel Aviv, Israel
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