Hi Maria ~
Over the years there have been a number of mothers I've known or have been
in touch with as a leader of a breastfeeding moms of twins (MOT)/higher
multiples (MOM) group, etc. who experienced rather significant blood
loss/intrapartum or postpartum hemorrhages with multiple pregnancy or
birth, resulting in extremely low H&Hs (hemoglobin/hematocrit); some did
receive transfusions. (For a number of reasons, significant blood loss is
much more common with multiple pregnancy/birth.) Yet many of these mothers
established milk production to exclusively express-breastmilk-feed or
directly breastfeed their multiple-birth infants. Those that didn't often
had an underlying cause that could have contributed to inadequate
production, e.g. PCOS or some other known or unknown condition associated
with insulin resistance; known or undetected thyroid conditions; other
pregnancy or birth complications - PIH, GDM, etc; certain medications
during pregnancy, birth, postpartum; significant delays in initiating
and/or inadequate milk expression or direct breastfeeding management; etc.
Has or is mother still dealing with edema, e.g. lower extremities?
I'd suggest assessing for additional factors that may be contributing to
low production. The blood loss history may be one reason, only part of the
reason, or completely unrelated to the low production. (Question - do you
know if she went into shock because of the hemorrhage?) In addition to her
lactation-related health history, what is this mother's routine for milk
expression -- how often, how long, with what, does it include both
mechanical and manual milk expression, etc? Is the mechanical breast pump
the correct one for this particular "job"? Are the collection kit
breastshields/flanges the correct size for her? Is she keeping a simple log
of milk expression? (I find mothers of premies often think they are
expressing milk much more than they actually are.) I'm a fan of visuals, so
I usually send a mother to Dr. Jane Morton's online video at
http://newborns.stanford.edu/Breastfeeding/MaxProduction.html. (I also
suggest she check out other selections from the menu at the left column.)
There's also good info re: UCSD SPIN (Supporting Premature Infant
Nutrition) via
http://health.ucsd.edu/women/child/nicu/spin/Pages/default.aspx and see
http://health.ucsd.edu/women/child/nicu/spin/spin-mommas/Pages/default.aspx
Mostly, I would really praise this mother for the colostrum she is
providing. There is NO substitute for it or the sIgA her babies are getting
from it! Please tell her to hang in... It's probably not possible yet to
know whether there is "hope" for increased production; that increased
volume may or may not "come in." Or it may come in better, yet it still may
not be enough to fully feed two babies. Who knows? Time will tell, but if
she stops expressing milk, it definitely won't happen. I can say that over
the years I have known several MOT who had long delays in adequate
production yet volume finally came after weeks to a couple of months. (See
Auer & Gromada, 1998; JHL for a case study with similar production issues
-- a MOM with quads.) In some cases, the moms were able to fully or almost
fully breastfeed or provide their milk later -- in others, they were able
to partially breastfeed or provide a good portion of babies' daily intake.
Wish it wasn't so "iffy"... All the best to this MOT who has a lot on her
plate and lots of stress with concerns for preterm babies. Really glad she
has you to support and help her!
Karen Gromada (author, *Mothering Multiples: Breastfeeding and Caring for
Twins or More*)
www.karengromada.com/
> Date: Mon, 9 Jan 2012 10:41:01 -0500
> From: Maria Yasnova <[log in to unmask]>
> Subject: Establishing milk production after blood transfusion
>
> Extensive blood loss in labour is known to cause delay in milk production.
> Does anybody have research to hand or experience on recovering and
> establishing full milk production after blood transfusion? Through lll i
> have a mother of premie twins 2 weeks old, milk has not matured yet and she
> is still expressing colostrum. Has she got any hope? Many thanks!
>
> ***********************************************
>
>
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