Respectfully, Jack, and others, yes, I believe you misread the original
posting, but it was a while ago now.

The *mother* is critically ill with HELLP syndrome (an anacronym for a
constellation of signs and symptoms which include Hemolysis, Elevated
Liver enzymes, and Low Platelet count). Although the writer did not say
she was critical, the condition begs the issue. "HELLP is associated
with a high mortality rate (0 to 24%)(Sibai, 1990). Maternal
complications can include DIC, acute renal failure, pulmonary edema, and
ruptured liver hematoma. The etiology is poorly understood" and
management is supportive. (Quoted from Nurses's Clinical Guide to
Maternity Care, by Aileen MacLaren, 1991. Springhouse Publishing)

This is why *mom's* bilirubin is sky-high. I personally think she is
having a hard time obtaining adequate milk from pumping because she is
in such an abject state of non-homeostasis that her body is in "survival
mode" and is effectively veto-ing requests to make milk (low item on the
totem pole when the body is struggling with basic survival).

The body's economy of things was once described to me this way: All the
organs sit at a large conference table - the heart and brain on one
side, and everything else on the other side (lungs, liver, kidneys, GI,
GU). Whatever the heart and lungs want, they get (maximum, immediate
veto power over all other needs). Digestion and lactation always lose
out to everything else.

I have taken care of precious few women in HELLP syndrome and, believe
me, I worked my tail off those shifts!! These are critically ill mommies
and scary patients to take care of IMHO! If she has the energy to pump,
I encourage it, but I remind her that she is doing it to stimulate the
milk ejection reflex and a pattern, but not to expect to see any milk
until a few days after her own condition has stabilized. In fact, I
encourage her to skip pumping for now, because we can always pick it up
as soon as she is no longer so sick (it is hardly "relactating" if done
within 2 weeks of delivery. Plus, she has me, an LC, to work with her at
that point).

I never followed up on these women very long, so I do not know how long
*mom's* hyperbili would last. Any OB types in the audience? I suppose
one could always track the *infant's* bili levels and that would be the
definitive answer - the concern is with how much the baby would absorb,
yes?

Katharine West, BSN, MPH
Sherman Oaks, CA