This is my first posting on Lactnet, so forgive the length -
I am working with a mom who has a coagulative disorder known as Factor V
Leiden.  She could not take Coumadin during pregnancy, but has resumed it
along with Lovenox postbirth.  She had a traumatic labor and delivery (Pit
for 27 hrs, followed by c-section after only dilating 3 cm).  Her milk
came in on day 5, and she had classic engorgement.  Baby was nursing ok,
but she pumped to relieve pressure (lactina) and stored ebm for later
use.  I saw this mom on day 12, and she has almost no milk.  Even
w/regular pumping, she is only able to get about 1/4 to 1/2 oz. per 30
min. session.  Baby has textbook latch, but only transfers about 2-3
swallows before quitting.  Obviously, no incentive as milk is not really
there.  They've been supplementing w/ebm 2 oz. q 3 hrs.  Very slow wt.
gain, has not regained bw and it's now day 14.  Mom went to a website for
women w/this disorder, and they all claimed it did not affect b/f.  And
Coumadin and Lovenox are not contraindicated w/bf.  The husband told me
that whenever they adjust her dosage of Coumadin, she's "out of
commission" for 2 days.  HELP!!!!  She doesn't want to supplement w/abm,
and I want to preserve what possibility there might be for her supply if
we can turn it around.  They're almost out of ebm (naturally). They're
having a wt.check this am, and will decide about supplementation.  FYI -
this mom's breasts do not look like lactating breasts - soft, no color
changes, no fullness or wt. to them - they look like breasts that have
never been thru pregnancy, let along engorgement!  HELP!

Liz Parrish, LPN, IBCLC
in private practice
Breastfeeding Solutions
Apex, NC

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