Jean Ridler asks whether it is realistic to expect full breastfeeding a
couple of days after mother comes to maternity ward from a ten day stay in
intensive care following a life-threatening hemorrhage.  She didn't
consistently get help to establish or maintain her supply until day 5, and
the assistance was spotty until she came to the maternity ward.

If the blood loss was accompanied by profound shock, it could affect her
pituitary long term, and you wouldn't just see a delay, but a reduction in
milk supply or even no milk at all.

I think the separation from her baby and the lack of stimulation from the
start, are going to have a stronger effect on how this breastfeeding turns
out.  Two days to bring in a full supply sounds very optimistic to me, but
it all depends on how willing she is to keep baby at the breast day and
night, and really give the baby unlimited access.  The main obstacle is that
a ten day old baby will not usually be satisfied with small volumes of
colostrum unless those small volumes are coming so frequently that they add
up to half a liter or so every day, and that takes some real
stick-to-itiveness on mother's part.  Where I live the staff would be aghast
at the suggestion to keep baby skin to skin all the time - 'she needs to
REST after what she's been through'  and in this case they could be right.
So at the very least she needs to know how to breastfeed lying down!

Obviously whether to give the baby supplements while mother works to build
her supply will depend on what you have available and what the mother wants.
If her supply is far below what baby expects, there is a very real risk that
the baby will start getting so frustrated at the breast that he almost
refuses to go there at all, whereas if he can be ensured a minimum of milk
so he stays in a good mood and in good condition, he can enjoy helping get
those mammary glands producing.

We once had a mother with a similar experience, a massive internal
hemorrhage following an elective CS, as it seems one of her uterine arteries
was nicked so she got a slow leak from that.  Only when she went into shock
did they realize that the terrible back pain she had been complaining of
since she came to the recovery area, was due to 3 litres of blood that had
collected around her right kidney, outside the peritoneum.  Eight units of
blood later she was off the ventilator and on her way to post partum.  I
cared for her on day 3, when she asked if it would be sufficient to start
breastfeeding the next day.  She hadn't had baby to breast before that, nor
had she pumped or hand expressed.  She had been unconscious or exhausted
most of the time since she was delivered, after all.  

Naturally I suggested she start on the spot, and her baby latched right on
without a moment's hesitation and guzzled beautifully for at least 15
minutes on the first breast.  Her baby continued to get formula supplements
for days and days but I attributed that to her culturally determined and
unshakeable belief that she would not make enough to satisfy him, at least
not at the start, with consequent insistence that he be given supplements
after many feeds.  He didn't get large volumes of supplement and she was
able to reduce the supplementation a lot before she left the hospital.

Never was there any sign that her production was impaired, despite
life-threatening shock from her blood loss.  I was prepared for the worst,
too!

We've had some memorable huge hemorrhages in my unit, and I have yet to see
a mother fail to bring in a full supply following one, as long as we take
steps to ensure adequate stimulation from the start and then keep at it.

Rachel Myr
Kristiansand, Norway

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