Vicki

Several years ago I worked with a mom in Harare who was - finally -
diagnosed with Sheehan's.  It took about three months for the family doctor
to finally work out that this had happened.  This was a second baby.  The
first had been successfully breastfed for many months and the mother was
very committed.  She was referred to me on about the fourth day postpartum
because the baby seemed unsettled.  She had had an attempted vaginal
delivery, attempted vacuum, then finally an emergency C/section and severe
heamorrhage.  As I recall, the Hb was about 7.

It was obvious to me right from the beginning that the baby was receiving
very inadequate quantities of breastmilk, but the paediatrician would not
believe me.  I suggested formula suppments after breastfeeding, with the
usual recommendations to increase breastmilk supply (breastfeed,
hand-express after breastfeeding, sulpiride to enhance prolactin
levels).  Nothing worked, although the baby's nutrition was protected
because of the formula.  The mother was very persistent about doing
everything possible to enhance her milk production over many weeks and I
was able to keep in close touch with her for a long time, but the
breastmilk never came in and she was heartbroken.

Eventually, well after the time that she should have recovered from the
C/sec and from the fatigue and ill effects of the haemorrhage she continued
to feel tired and sluggish, losing hair, and gaining weight, especially she
said round her middle!  It was the unwanted weight gain that finally
prompted her to seek medical advice.  Blood tests showed raised cortisol
levels, low thyroid and skewed pituitary/adrenal levels etc (going from
memory here ...) and suddenly there was a panic as it was realized that she
had Sheehans and was very sick indeed.  She was treated and eventually
recovered, but it took a long time.  She was told that she would be unable
to have any more children, and the whole situation was tragic.

After this experience I always warned mothers I worked with who had had
severe pph to keep in touch with their doctors and request checks of
hormone levels and pituitary function for many months.  I worked with one
other mother who had a similar calamity, though she was followed up much
more closely, however once again the milk never came in.  In Zimbabwe it
was difficult to persuade the doctors and paediatricians that lactation did
*not* follow parturition, as day follows night, but - armed with the first
experience - I was able to be very clear that this was happening and
mention Sheehans as a possible cause.  Again, this mother remained very
very sick for many months, and was also advised that she would never be
able to have any more babies.

Hope these two (very incomplete) case histories help.

Pamela Morrison IBCLC (now living in Brisbane, Australia)
[log in to unmask]

Vicki wrote, "I'm am seeking any/all info on Sheehan's syndrome and it's
effect/ prognosis
for successful breastfeeding. We have a Mom who was just diagnosed today at 9
days pp. I would truly appreciate whatever input anyone has."

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