I'm nomail so please send me a copy off-list of any suggestions you might have.
Grueling 4 days of induction for PIH at about 38 1/2 weeks.
Grueling long labor.
Grueling birth w/vacuum extraction after 2 1/2 hours pushing, baby's head
visible much of the time.
PP hemorrhage of reportedly around 1500 ml, with drop in blood pressure
from 140/90 to 90/?.
Baby had initially low Apgars.
Patient was not anemic before delivery but was anemic afterwards, though I
don't know the numbers.
Baby took a day to latch well, but by the time I saw them at 3 days
postpartum he was a very "nursey" baby. When I saw him he had been put off
for too long and had been crying. He came to the breast w/furrowed brow
and eyes fixed on mom's face, latched cleanly and deeply, nursed vigorously
w/o discomfort to mother, alternated flutter-sucking and repeated long
draws, forehead and hands relaxed most of the way over the course of
breastfeeding, mother basked in hormonal glow, baby dozed off and
self-detached after approx. 15 minutes. Things looked good. At that time
I was unaware of the severity of her hemorrhage/drop in BP, and though I
noted that she had no signs of her milk coming in, that was not unduly
worrisome on day 3.
Today I heard a nurse describe the blood loss and say the baby was acting
hungry by discharge later on day 3 which worried me so I called the mom who
was on the ragged edge after nursing all night (one 1 1/2 hour nap), baby
having brown stools 1-2/day, also too few wet diapers which are yellow not
clear, baby very dissatisfied. (Despite baby crying day before, she is
responsive and I believe her report of amount she is nursing him.) Mom
sees colostrum on nipple and on baby's lips after nursing but has no signs
of engorgement/milk coming in at 100 hours postpartum (4:30 PM Sat- 8:30 PM
Wed). Baby also clinically jaundiced (cephalhematoma) but not sleepy so far.
We discussed her options and she decided to have her mother bring her an
SNS and some formula to supplement at breast tonight. Her doctor
concurred. I have also recommended going to bed w/baby skin to skin and
nursing 10+ times/day, and taking plenty of fluids. She's taking iron
supplements.
This is my first PP hemorrhage mom having trouble with milk supply and I
hope to goodness it isn't Sheehan's syndrome. I have searched the
archives. My remaining questions are:
1. How long would you expect it to take for her milk to come in based on
your experiences?
2. If this is likely to last more than another day or two, do you find
oxytocin nasal spray, Reglan, Domperidone, fenugreek, and/or goat's rue (or
any other drugs/herbs) to be helpful in such a situation?
Elise
who really, **really** doesn't like inductions...
Thank you!
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