Greetings,
I would love some insight:
Primip age 41 - induced labor for chronic hypertension, which elevated
further during pregnancy, progressed to c-section, apgars 9-9, bw 5#13 oz,
dropped a little, but started supplementing early on due to baby refusing
to latch, so by 1 week of age, when i saw family, baby was near
birthweight. No breast changes during pregnancy, no feeling of fullness or
engorgement, expressing with a rental pump, only able to get 5ml combined
both sides (one time she got 15, but hasn't repeated.) No PCOS,
infertility, breast problems, or irregular cycles. No known history of
thyroid issues, or other hormone problem, just chronic hypertension,
treated with labetelol, 200mg BID. No mag sulfate during delivery.
Our plan was pump more often - after every feeding (she had been pumping
only 2-3 times per day), feed at breast with sns (baby did BeAUTIFULLY with
this when i was there), use nipple shield with SNS if baby doesn't latch
consistently (parents reported on and off breast behavior) and finger feed
if breastfeeding really isn't working at any given feeding. Family opted
to try domperidone, which they started the day after they saw me, 20mg, 4x
per day.
I spoke with mom today, 1.5 weeks later, and basically nothing has
changed. her blood pressure has been up and down a bit - lower in the
docs office, but high the last time she checked it at home. still pumping
only 5 mls, even with more frequent pumping, no sign of retained placental
fragment, baby nursing at breast a few times per day, and finger or bottle
the rest. Mom pumping after every feeding. No apparent response to the
domperidone, yet (mom knows it might take a while.)
What I would love is any info anybody has about chronic and PI hypertension
and breastfeeding - it is my month for that topic, i guess - this is the 3d
mom!
What is the mechanism for suppressed milk supply? mom did not seem
particularly edematous . . .
i am chasing a red herring with the Hypertension?
why no breast changes during pregnancy? does the vascular issue affect
breast changes the same as it affects gestational size of the infant? if
blood pressure is brought under control, does milk supply sometimes
rebound, even when it is this low at 3 weeks PP? what else might help this
mom bring in more milk? I would love to hear about other cases similar to
this or articles/research that might illuminate the situation, as well as
anybody's musings. Please also let me know in your posts whether it would
be okay to share with the mother. Thanks a lot!
Lyla Wolfenstein, B.S., IBCLC
www.beyondbirthservices.com
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Lyla Wolfenstein
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Lyla Wolfenstein
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