A previous thread on LactNet served me well this last weekend, but I
don't recall if we reached any conclusions. Perhaps this situation
(following) has some different twists anyway. I would be pleased to hear
your thoughts.

I discussed bringing in milk this weekend with a mother who never had
any come in (and this is truly the case). She was delivered by
C-Section, twins, at 33 weeks, 2 weeks ago. She had severe PIH, was in
Cardiac ICU both before and after delivery because of massive
third-spacing of fluids, including pericardial edema, pulmonary edema,
and renal failure. She was on magnesium sulfate for several days
postpartum, still in CICU, before stabilizing enough to go to the
maternity floor and then home. She has lost nearly 60 pounds of water
weight. She only just stopped taking diuretics and has not been cleared
yet as being hemodynamically stable by her internist and
endocrinologist. She reports great difficulty sleeping and is exhausted
- hardly able to hold her babies (who are stable weighing 3-1/2 pounds).

She wants to BF very much and is tearful when she told me no milk ever
came in. Two days postpartum, (2 DAYS!!!) the hospital LC showed up in
the CICU with a hospital-grade electric pump and told her she had to
pump every 2 to 3 hours *around the clock* or she wouldn't get *any*
milk in, and once it was gone-it was gone. (This advice makes me furious
- this mom *couldn't* have been stable fluid-wise at 2 days postpartum
to make milk, let alone in any other way. I think it also reveals a
colossal lack of knowledge and understanding about the lactation
process! Am I off-base here or what?)

Mom tried pumping anyway (!) (and why didn't the CICU nurses intervene
on her behalf?! Don't answer - it is a rhetorical question) and told me
apologetically, "I just couldn't do it, so I have no milk." She has
returned the rental pump.

I spoke with her and her husband at length about the lactation process,
particularly as I see it in relation to what her body has gone through.
I would like feedback from my closest 1384 friends on LactNet if you
would have suggested anything different.

Also, what do you think her risk of having acquired Sheehans's Syndrome
and how could one know? Did we arrive at any definitive answers when
this came up earlier?

I suggested she not even think of pumping until she was fully medically
cleared by both internist and endocrinologist, suggesting she ask both
of them if they thought her body ready to produce milk. Once she has
been medically cleared, I suggested a one-week trial of double-pumping
for 10 minutes, choosing pumping times she could stick pretty close to
(ie- no erratic time schedule) of at least 4, preferably 6 times during
her waking day (ie - no nighttime pumping). She would know at the end of
7 days if she were on the right track. (See, I'm wondering if she has
Sheehans - I think 1 week is reasonable to sort that out?)

I did explain to her, without giving any diagnostic labels, that it is
possible her PIH experience may have indeed interfered with the
lactation process, but if it didn't, she could still bring her milk in
once her body had recovered (giving examples of various well-known
relactation scenarios). I also suggested fenugreek, and all the usual
stuff we teach re: increasing milk supply otherwise. She was so
encouraged and quite relieved to hear all this.

BTW, in case you read my other posting, Subject: LactNet Advice for LC
Advice, these were the same "Lactation Nazis" talking to her. (grumble,
grumble)

Thanks in advance - It is possible I might get assigned to that NICU
next weekend as well (June 20 and 21) and can follow-up with her and
share your advice.

Katharine West, BSN, MPH
Sherman Oaks, CA