Greetings,

I have permission to post.  I've been in contact with a first-time mother who has had several perinatal health issues and very low milk supply at 1 month post-partum.  I would very much appreciate some experienced insight.  Issues:

--Mom was in very bad shape after delivery (39 weeks, unmedicated spontaneous but with an episiotomy) due to acute fatty liver disease of pregnancy that was discovered post-partum.  She was in the ICU for 4 days and mostly separated from her infant.  Breastfeeding establishment was delayed.  She began pumping with assistance but has never gotten more than 15 ml from both breasts combined.  The baby began receiving formula soon after birth but was also put to the breast during visits when mom was able and then at every feeding once she was out of the hospital.  She never got the sensation of her milk "coming in."

--About 10 days post-partum mom began experiencing severe abdominal pain and was re-admitted.  A large dermoid cyst (cystic teratoma) was found on ultrasound as well as necrotic placental fragments.  Mom had surgery to remove the teratoma, a D & C to remove the placental fragments, and was put on intravenous antibiotics for several days.  During that time she opted to pump and dump her milk and was using a Lactina every 2-3 hours and getting anything from 5-10 ml at each pumping session.  A few days after the procedure she noticed a slight improvement in her milk supply.  Her breasts started leaking occasionally and feeling a little more full.  Pumping sessions were slightly better; around 15 ml per session.

I saw mom and baby in their home on Friday.  I showed mom and dad how to use the SNS for feedings.  The plan is to use the SNS with formula and hopefully taper down and increase her milk.  Mom is very sick of pumping and anemic and tired so she prefers to use the SNS and pump as little as possible.  I suggested putting the baby to the breast as often as possible, hand-expressing for just a few minutes after feedings, and then pumping a few times a day after feedings if possible.  She had purchased a bottle of More Milk Plus capsules and told me that she's been taking them for just a few days.

After the D & C the surgeon told her that there were placental fragments in her uterus still that weren't able to be removed.  I am not sure why.  I suggested maybe she should get a second opinion on that but she is somewhat traumatized by all the procedures and separations and didn't seem too interested.  I know teratomas can mess with a woman's hormones; is there any value to getting, say, her testosterone levels tested?

Thanks in advance for whatever insight you might have!  

Erin Michaud, BA, LLLL, NMC, CLC

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