I'm very much a newbie, anxiously waiting to hear my board results, but would like to share a situation I encountered a couple of months ago. Our hospital receives maternal/neonatal transports from outlying rural counties, and this one young mom with pre-eclampsia began having seizures in her 35th week and was airlifted to us to have the baby. She had the baby by emergency cesarean and our lactation dept. was consulted to come up to the Neuro ICU. She had greatly desired to breastfeed the baby and family members were at the bedside. When I saw the mom, she was on a respirator and heavily sedated, tongue swollen and hanging out of her mouth, and edematous. The doctor happened to be in the unit, and was all for our helping this mom. The husband reiterated that she had wanted to bf, so I showed him how we could pump his wife. We obtained some precious colostrum, which I was able to carry down to the baby in NICU. The next day, our lead
consultant talked with the Neuro ICU nursing staff and they also did some pumping. How amazing was it to see that mom get better and on the third day, come to the regular mother-baby unit. Even more amazing was to help her breastfeed her baby in the NICU a week later.
Regarding the nutritional/medical burden on the mom you mentioned, lactogenesis II would happen anyway, barring Sheehan's, would it not? In the case of the mom I assisted, the mom's wishes were also considered. By helping her to do what she had planned (and I talked to her the whole time, even though she was nonresponsive), we thought we were actually aiding her recovery. A few months earlier, we also had a young girl in the Cardiovascular ICU who for religious reasons would not accept a blood transfusion after her post-partum hemorrhage. Her hemoglobin was something like 4 or 5. She was alert, and wanted to pump also, so we helped her. She did receive some kind of volume expanders and iron, but there was no problem with her pumping. Both these women were basically medically stable, although very ill, and had family members willing to assist them achieve their goals. If the family members (or spouse) of the woman you mentioned were
giving consent for her, and the physician is OK with it (and as the mom's advocate, you could lobby him or her), the nursing staff should go along, is my gut feeling.
--- On Wed, 9/2/09, D Dowe <[log in to unmask]> wrote:
From: D Dowe <[log in to unmask]>
Subject: when mother is in ICU
To: [log in to unmask]
Date: Wednesday, September 2, 2009, 9:09 PM
I recently had the occasion to be called for a lactation consult for a mother
who was in surgical ICU after a severe post partum hemorrhage. Without
going into all the details, the mother was intubated on a respirator and heavily
sedated, unable to communicate. Putting the issue of the severity of the
hemorrhage aside (Sheehan' syndrome, hypovolemia, etc), some of the ICU
nurses were concerned with the caloric requirements/ burden that pumping
would put on this patient, that it would delay her healing. I am not an ICU
nurse- adult ICU is WAY beyond my comfort level! - so I am not familar with
the nutritional challeges of a critically ill adult. My gut reaction is that
pumping would not be that much of a risk to this woman. Even if this woman
had suffered a pituitary infarct due to the hemorrhage, I felt that we had an
obligation to try to establish a milk supply.
Is there anyone on Lactnet who is familiar with adult ICU situations that might
explain this to me? Or, are the ICU nurses making excuses to not pump this
mother?
Thank you in advance.
Debbie
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