I agree that a mom who is critically ill may not be able to produce much milk volume *while she is critically ill.*  There is probably scant research to support this but if she is still requiring ventilatory support I would be astounded if she were to go through Lactogenesis II normally.  I can't think of how either fentanyl or midazolam might directly depress lactogenesis; a quick lit search even gave me a couple articles asserting that fentanyl administration actually *increases* serum prolactin levels (though this would certainly not be a first-line approach for increasing milk production). :)  

It does sound like this poor mom really went through a horrifying delivery and needed a massive resuscitation.  Unfortunately, when a patient abruptly hemorrhages, we often end up needing to give a huge amount of volume at the time of the blood loss -- which then ends up outside the intravascular compartment within the next 12 hours or so.  This then causes significant edema and even respiratory failure that can require days of aggressive diuresis to treat the pulmonary edema.   This residual edema combined with the initial hypovolemic shock (which *could* cause Sheehan's Syndrome, but it is still somewhat early to be able to tell for sure) is much more likely to be the cause of her lack of milk production.  So glad there is banked milk available for her infant.

I hope she's starting to improve -- trying to keep otherwise healthy young patients comfortable while intubated is no easy or fun task.  *Way* off topic here, but I really like the drug dexmedetomidine in these situations...

Best of luck to this new mom,
Sarah Reece-Stremtan M.D.
Pediatric anesthesiology fellow in Washington DC

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