Last year I had two cases which puzzled me in regards to decreased milk
supply-Sheehan's syndrome, after a postpartal bleed.  The first case was a mom
who had regularly attended LLL meetings and had breastfed her first child over a
year.  She had a hemorrhage and needed a couple of units of blood after her
second child, but went home after 48 hours.  She never got over a trickle of
milk although she nursed frequently, pumped also, and did everything by the
books.

The second one was a real puzzler.. This mom was also a LLL mom, who had nursed
her children for long periods of time.  Her husband was head of the nutrition
department in a chiropractic college, so was really "into"  breastmilk
nutrition.  At around 34 weeks gestation, she developed HELLP syndrome and began
bleeding internally.  She was critically ill, and received  over 85 units of
blood .  Her husband was told she had less than a 5% chance of survival.  The
baby was born via C/sec. and was healthy.  I met with her husband .  He was
distraught over his wife, but also concerned that the baby receive only breast
milk.  He was able to solicit donated milk from his chiropractic students and
their wives, and they were tested for HIV and other infections, and then used as
donors.  The mom was in a coma in intensive care, and on day 5 of her stay, I
was called to the NICU to help them pump her milk because she was engorged.  Her
breasts were hot and swollen, and due to the fact that she was on a respirator,
we had to double pump her every couple of hours while she was flat on her back.
She developed an adequate milk supply.  After a couple of days, she became
conscious, and I went to visit her.  She had been told that because of the large
amount of milk she had received, over 100 units by then, she should not take a
chance on feeding it to her infant, due to the chance that she got some HIV
contaminated milk.  I talked to someone at the CDC, and they assured me this
would not be the case, and also spoke to her husband, but she was so frightened
that she did not want to take any chances.  We helped her dry up her milk.  She
was hospitalized for a few more weeks, and recovered.  I was really
flabbergasted that she got milk under the circumstances.  She had a hysterectomy
during the crisis to help control bleeding.  It was one of the most interesting
cases I have ever had.

Ann M. Calandro, BSN,RNC, IBCLC