Hemoglobin and hematocrit levels are expected to be low after a significant 
postpartum hemorrhage, which is correlated with delayed lactogenesis and 
Sheehan's Syndrome.  

Approximately 8 years or so ago in an inpatient setting, I met with a mother of 
multiples who had delayed lactogenesis with reported onset on Day 9 following 
a greater amount of blood loss associated with cesarean birth and 
complications that followed.  For example, following a complication with a 
cesarean birth and a subsequent return to the OR, a mother's hemoglobin level 
could drop as low as in the 6 range.  Have been in private practice for a while 
and don't have lab values at my fingertips, but I believe a normal hemoglobin 
range for females is 12 to 16 (please someone correct me if I'm mistaken on 
this).  For various reasons, some mothers may decline a medically  
recommended blood transfusion for situations of greater volumes of blood loss, 
and a delay in lactogenesis is not surprising.  As a less-experienced LC back 
then, I recall a more experienced colleague commenting that a woman's body 
must get back in to balance re: dramatic blood loss and the regeneration of 
red blood cells, etc. for the woman's overall wellbeing, before her body can 
expend the necessary energy on milk production/lactogenesis II (more RBC's 
to the mammary glands during lactogenesis II).  

Debra Swank, RN IBCLC
Ashburn, Virginia USA

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