<I am wondering if anyone out there has a research reference concerning the
above. I have noted that women with a low haemaglobin (below 74g/l) often
have difficulty lactating - especially the primipara....>
Verity Livingstone and Claire Willis wrote up a case series of ten women who
had a severe postpartum haemorrhage and insufficient milk supply. I have
copied the abstract from PubMed, below. I cannot believe this was published
in 1995! I've pulled out my copy of JHL to confirm this - and found this was
the issue with the great editorial by Di Wiessinger - the story of three
sisters (worth re-reading).
There was also a study published in Birth (see abstract below). I think you
need to read the whole paper as the association between low supply and
anaemia was "suggestive" in their study, rather than conclusive. This may be
because the sample size did not have enough "power" to identify a difference
between women with low Hb and "normal" Hb (or other methodological
problems).
Lisa Amir
MBBS, MMed, IBCLC in Melbourne, Australia
PS. I am still waiting for my Feb JHL - do any other Aussies have it yet?
J Hum Lact 1995 Jun;11(2):123-6
Infant insufficient milk syndrome associated with maternal postpartum
hemorrhage.
Willis CE, Livingstone V.
Insufficient milk syndrome is defined as failure to thrive in infants due to
insufficient daily breastmilk intake. This discussion examines a possible
association between insufficient milk syndrome and maternal postpartum
hemorrhage. Ten consecutive cases of insufficient milk syndrome associated
with maternal postpartum hemorrhage were identified. The mothers presented
between 3 and 35 days postpartum. Maternal postpartum blood loss ranged from
500-1500 ml in eight cases (mean: 963 ml); in two cases, blood loss was
noted as 400++ and 200++, respectively. Six mothers experienced a drop of
hemoglobin by > 30g/L; two had a drop in blood pressure > 30mmHg for > 20
minutes. All infants were failing to thrive. Five infants suffered
hypernatremic dehydration with serum sodium levels ranging from
148-166mmol/L. Breastmilk electrolytes were measured in six cases, and
elevated sodium levels, ranging from 21-100mmol/L, in five cases. These data
serve to heighten awareness of insufficient milk syndrome as a potential
consequence of postpartum hemorrhage. Early postpartum review of all
breastfeeding mothers and infants is strongly encouraged.
Birth 1995 Jun;22(2):86-92
Anemia and insufficient milk in first-time mothers.
Henly SJ, Anderson CM, Avery MD, Hills-Bonczyk SG, Potter S, Duckett LJ.
Insufficient milk is a poorly understood problem that is often identified as
a major reason for early discontinuation of breastfeeding. This study
explored the relationship between anemia and insufficient milk in 630
first-time mothers. The frequency of anemia (postpartum hemoglobin < 10
g/dL) was 22 percent. Anemic mothers reported a higher level of
symptomatology associated with insufficient milk and were more frequently
classified as having insufficient milk syndrome. Mothers with the syndrome
reported a shorter period of full breastfeeding, and weaned at an earlier
age. They identified not having enough milk, baby nursing too often, and
baby not gaining enough weight as the main reasons for discontinuing
breastfeeding, compared with baby's disinterest and conflicts with school or
work as main reasons among mothers not reporting symptoms related to
insufficient milk syndrome. The study results suggest that anemia is
associated with the development of insufficient milk, which in turn, is
related to duration of full breastfeeding and to age at weaning.
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