Dear Colleagues:
    The pituitary can become damaged on a continuum of  injury: from totally 
and permanently infarcted to shocked and temporarily  malfunctioning to 
chronically underfunctioning (sub-clinical Sheehan's syndrome,  estimated to affect 
about 600,000 women world-wide). The new, 6th edition of  Lawrence and 
Lawrence suggests that prolactin-stimulating drugs, such as  sulpiride, require 
investigation, and mentions that the degree of  hypo-pituitarism is variable.
    I worked with a mother once who lost her milk  supply as a result of a 
postpartum hemorrhage (about the 7th day, as I recall),  and required 2 units of 
blood. It took nearly a month to recover her supply; she  had been nursing 
well until the hemorrhage. The baby was supplemented with human  milk 
substitutes at breast, she pumped and the milk trickled back in. 
    I also had a sub-clinical Sheehan's syndrome  myself, which didn't appear 
to have any impact on my supply. I nursed my baby  and pumped an additional 
6-10 ounces once a day.
    As with everything else in our work, there is no  one answer. Best to 
suppport what is there, stimulate the nipples, feed the  baby, and see what 
happens, knowing that it might take more than a few  weeks.
    warmly,
Nikki Lee RN, MS, Mother of 2, IBCLC, CCE
Maternal-Child Adjunct  Faculty Union Institute and University
Film Reviews Editor, Journal of Human  Lactation
Support the WHO Code and the Mother-Friendly Childbirth  Initiative

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