Hello Merete!

I have been working with a couple of mothers with the breast trauma (one 
accident and a couple of moms after abscesses). One mother had been in a car 
accident and was stuck under a car on one side of her body at the end of her 
pregnancy. Several ribs were broken and needed surgical treatment and she 
needed treatment in the ICU for a couple of days. The baby was at our ward 
and needed special care also after the cesarean was done when the mother was 
stable enough for it. The baby recovered well after baby´s system managed 
the pain medicines the mother had needed prior the cesarean.

The ICU staff started wondering about mother´s milk starting to flow around 
4 days postpartum and the father got advice from us pediatric RNs what to 
do. Our ward loaned the pump and he delivered the pump to the mom. I met the 
mother about 6-7 days after the baby had been born when she came back from 
the ICU (another hospital) to the surgical ward with pleural tube etc. I 
took the baby to the mother and helped her to breastfeed the baby and then 
later that same day to help and teach her to pump her breasts. I am glad I 
took the time when I saw the breasts better (luckily our ward was not full 
that time). The ICU RNs had helped her to pump only a couple of times and 
the breasts where becoming engorged. The traumatized breast was more 
swelled, tight and darker and had hematomas. The trauma pain was managed 
with post-op. "epidural pain pump" so that side was a kind of dumb and the 
mother did not feel the pain and she got other pain medicines also. I gently 
helped her to pump both breasts, she could not do it by herself since it was 
too painful to adjust position or move hands. Then I looked for the surgical 
nurses and told them that mothers breasts needed imediate care and told the 
basic treatment for engorgement (cold and frequent enough pumping). I 
suggested that the IBCLC of our hospital should be contacted in the morning. 
They did what was needed, not the quite the frequency that is suggested but 
well enough. The IBCLC visited the mom the next day.

We were in time, the breasts got better and she did not develope mastitis on 
the trauma side (which I was worried when I saw the breast). The baby nursed 
at first twice a day (the mother was so much in pain that she could not 
tolerate more) and mom pumped. When the mother recovered the milk came more 
plentiful. The mother was incredible brave and started to come to the baby´s 
ward to breastfeed. (The surgical ward could not arrange a single room for 
the mom and was worried for the baby´s health after they had to take another 
patients to mothers room.) They needed nurses help to move and position the 
baby to the breast and to transport the mother between the wards.

To cut this short: the mother got about half of the milk when the baby went 
home. After a week at home with the mom, she breastfeed 6-7 times a day and 
needed supplementation only a 2-3 times a day. The trauma side breast made 
less milk during the hospital stay but the amount was increasing also on 
that side and the hematomas dissolved. It is so cool to see how the mother´s 
bodies do they best to recover and the milk start to flow after even this 
kind of situation.

I have been talked with  the two IBCLCs of our organization that we 
obviously need to educate the staff of our ICUs and surgical wards about the 
breast management also in the future.


Warmly,
Pia Ruohotie, RN and breastfeeding counsellor
from Helsinki, Finland 

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