Linda,
I have also researched this and simply come up with very little addressing
breastfeeding directly. I've had a couple of moms I've counseled who had one
of these forms; one mom in particular had a perfect clean history except for
the placental issue. It was removed and she was treated with methotrexate, I
believe, for a short period of time. But her milk never came in well at all.
I've also spoken with Pamela Berens and she's also known of a difficult case
that did not resolve well.  What I don't know is how often this happens and
lactation proceeds normally anyways-- I just see the problems. So often
mothers never even tell their HCPs when lactation doesn't occur
successfully.

When it comes to leaving the placenta in, my greatest concern is for how
long it will issue progesterone and interfere with lactogenesis II. By
theory I expect this to be a significant problem.  If the mother is treated
in this manner and you have the opportunity, perhaps her progesterone level
could be monitored frequently to see what happens. I don't think anyone has
ever done this and the information would be so valuable to the rest of us. 

Did you find the following JHL 17(2) 2001 article?

Disruption of Lactogenesis by Retained Placental Fragments 
Ann M. Anderson, RN, BSN, IBCLC 

This case report describes a situation in which lack of milk production led
the mother to seek help from a lactation consultant in private practice.
Despite extensive breast stimulation with the baby at breast and mechanical
breast expression, no milkwas produced. Retained placenta was suspected by
the lactation consultant. The mother was later diagnosed with placenta
increta. Only when this condition was diagnosed and resolved did milk onset
occur. It is important to evaluate for retained placental fragments when
lactation appears to be delayed. 

I would love to hear more about this case as it progresses.

~Lisa Marasco

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