Debbie,

I am definitely not an ICU nurse, but I've worked closely with two 
mothers who had Sheehan's, and I had a client who was exclusively 
breastfeeding a 4 month old, admitted into the ICU after scheduled 
brain surgery, who booked me in advance to do hospital consults to 
help protect/maintain her milk supply.

The two postpartum haemorrhage mothers produced no more than a 
glisten of breastmilk, ever, in spite of frequent expressing and all 
efforts to bring in a milk supply.  They had been highly motivated to 
breastfeed (one was an LLL mom who'd breastfed her first baby for 
over 18 months) so the result was heart-breaking.  But primary 
lactation failure is one of the markers for Sheehan's.

At my first post-op visit to the mother who had had surgery, I went 
in expecting a fair degree of breast overfullness.   I was amazed to 
discover soft, flaccid breasts.  I duly taught each shift of ICU 
staff how to hand-express to prevent engorgement and maintain the 
milk supply, but there was never any need - it was almost as if the 
mother's body had abruptly shut down milk production.  After 3-4 days 
the mother was moved to the HDU, and as she gradually recovered from 
her surgery so her milk supply gradually returned and I was then able 
to hand-express her milk and, when she was well enough and able to 
sit up, she took over this task herself.  She went home and continued 
to breastfeed.   If I hadn't seen it, I wouldn't have believed that 
this sudden _lack_ of milk after the surgery would have been possible.

The lesson I learned from this (and from another mother who had a 
very severe car accident also while exclusively nursing a 4-month old 
and also virtually completely stopped lactating for about a week) is 
that when there has been severe blood loss and/or trauma, breastmilk 
production appears to be so negatively affected that there may be no 
need to pump/express immediately after the crisis;  it seems that 
only as the body is recovering does it slowly "remember" to make 
milk. So your question may be superfluous.  I would think that good 
postpartum management of your client would include assessment of 
breastmilk production by examining the breasts daily or twice-daily 
and attempting to express, to see if Lactogenesis II is imminent.  If 
it is, then expressing/pumping would be good, _if_ the breasts start 
to fill so as to prevent engorgement/mastitis, adding to her medical 
problems.   But if there is no milk (as I would suspect) then trying 
to stimulate a supply now would not be useful.  Actually, it wouldn't 
impact on the mother's nutritional status because it sounds as if 
there would be no milk being produced at all.  There will be time in 
the future, as the mother's physical condition improves and her Hb 
count returns to normal, to see if milk production commences, and if 
not, then to try and "artificially" induce lactation for the 
baby.  For now, it's sad if the baby has to be fed formula, but it's 
one of those times when we can be thankful that breastmilk 
substitutes are available to feed a baby when lactation fails.

Pamela Morrison IBCLC
Rustington, England
-----------------------------------------
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

              ***********************************************
    

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome