Lisa

If ever there's a tragic situation it's Sheehan's, and the 
circumstances of the mother you're working with sound especially 
sad.  I've worked with two cases and I hope never to see 
another.  With the first, it was the mother's second baby. She was an 
LLL mom too and had breastfed her first baby by the book.  Although 
she'd had a horrible birth, a failed vaginal delivery, subsequent 
C/sec and severe heamorrhage, she was highly, highly motivated to 
breastfeed and just naturally expected that she would.  She was 
referred by her extremely baby-friendly paediatrician on about Day 4 
because the baby was hungry and jaundiced.   Mother was producing 
literally a glisten of colostrum, and that was it. The milk simply 
never came in.  The paediatrician couldn't believe it.  The mom was 
eventually persuaded to start formula supplements, and continued to 
put the baby to the breast for weeks, before and after the formula, 
while we both hoped that this was just a case of delayed lactogenesis 
and that frequent nursing, and sulpiride would do the trick.  I'm 
afraid it didn't.   I was able to keep in touch with her for many 
many months and she later experienced depression, extreme fatigue, 
dry skin, her hair fell out in handfuls and she put on a lot of 
weight.  Her doctor became extremely worried about pituitary and 
adrenal dysfunction, and she needed treatment for several months.

The second one was a first time mother whose OB had somehow cut into 
an artery while doing an episiotomy.  She lost a lot of blood.  Once 
again the milk simply failed to come in, against every expectation, 
though because I'd seen this happen before I realized what it was 
more quickly.  The baby received formula fairly promptly, while the 
mother continued with breast and bottle for a short time, but once 
again there was no evidence of any breastmilk production.  She too 
had ongoing health problems.

It would seem to be important to encourage a mother with Sheehan's to 
continue efforts to bring in a milk supply, but with the caution that 
some mothers do bring in a partial or full milk supply several weeks 
after a postpartum haemorrhage, but that with true Sheehan's, it just 
may not be possible.  If the mom can feel that she has done her best, 
then it may help her to more easily come to terms with the sadness of 
what has happened.  She can, of course, continue to nurture her baby 
at the breast, regardless of milk production, the same as any other 
mother.  She also needs to keep in touch with her doctor  to have her 
own health monitored for several months.  This is one of the few 
times when we can be thankful, though sad, that formula is 
available.  Maybe you can keep us posted on her progress over the 
next few weeks?  Fortunately Sheehan's is rare, but we need to learn 
more about it.

Pamela Morrison IBCLC
----------------------
Permission to post: mother with confirmed Sheehan's syndrome after severe
postpartum hemmorhage. Prolactin levels now at 9 (two weeks after birth).
Mom started pumping right away (baby in intensive care), got small amounts
of colostrum in first tries, then nothing.

This is the mother's fourth child, breastfed all previous children, her
mother was a LLLL, she is very dedicated to doing anything and everything to
produce as much breastmilk as possible. She is currently using a nursing
supplementer.

I have searched the archives, and can't find answers to my questions:

Other than the case in Lawrence, does anyone have experience working with a
mother with confirmed Sheehan's syndrome who was able to establish
lactation? If so, what was done?

The mother would like to try oxytocin nasal spray (as used in the Lawrence
case). Lawrence says syntocinon is no longer available. Mother has a doc who
will write a scrip, but what does he write it for? What is the dosage?

 From the Lactnet archives, it seems that Reglan doesn't make any sense when
there is a damaged or destroyed pituitary, but domperidone might be better.
Any experience with this?

I welcome your input!

Lisa Mandell, MBA, IBCLC
Havertown, PA

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