Hi Laurie ~
Wow, this poor mom has really been through it! Would think the blood loss
followed by high fever could have an effect. But what caused the high fever?
Did mom go into actual shock with the blood loss or was staff on top of it
right away and compensating? What is her H&H - and what was her lowest after
the blood loss? What are her ankles like - any edema? Does she have any
other condition (or has she had related signs/symptoms) that can contribute
to low production, e.g. thyroid (changes fairly common with
pregnancy/postpartum), PCOS, etc? (I'm assuming but shouldn't that she's not
had breast or chest surgery or trauma since having her previous baby.)
Has her pump been checked for any possible mechanical problems? Do the
flanges/breast shields fit correctly? How many bars does she have up re:
vacuum pressure when pumping? Is she doing RPS immediately prior to pumping?
Is she truly pumping q3h for 8x/24 hours? If so, when does she sleep - does
she need the plan revised a bit to ensure at least 8 sessions per 24 hours
but allow for a 4-6 hr block of sleep at times? Does she keep a simple log
of her pumping sessions? Has she tried any "power pumping" techniques? Has
she watched/tried any of the techniques at
http://newborns.stanford.edu/Breastfeeding/MaxProduction.html (for moms of
prems but many pumping moms find these ideas helpful)? Has she tried
"recycling" through the stim phase 2 or 3 times within a pumping session?
Does she have enough household help so she can stay in bed or on the sofa
and kangaroo her newborn (which is associated with better milk volumes)
between pumping sessions? Many moms feel extreme fatigue for weeks to months
following significant blood loss even after replacement transfusion.
Although I'd keep Sheehan's in mind, there may be other issues. Most of the
moms (a number have been mothers of twins) I've known who've had postpartum
hemorrhage (PPH) still produced adequate milk for their babies.
Hope this is of some use... on the run!
K
> Date: Sat, 25 Sep 2010 11:21:52 -0500
> From: Laurie Shornick <[log in to unmask]>
> Subject: Possible Sheehan's Syndrome
>
> Dear Lactnetters,
>
> I am posting for a colleague who is dealing with a mom with possible
> Sheehan's Syndrome. We have permission to post.
>
> This is mom's 2nd baby - she nursed her first child for 18 months,
> never any milk supply issues even following a C/S. This time around,
> she Vbac'ed, had a traumatic forcep delivery that resulted in post-
> partum hemorrhage. She needed two units of blood, and had severe
> hypotension. Her son is one week and two days old, was hospitalized
> for dehydration because she had no idea from his vigorous, frequent,
> nursing that he wasn't getting anything. She is pumping (with a
> Symphony every 3 hours) but can't produce anything more than drops of
> colostrum. She has had an ultrasound, and there is no evidence of
> retained placenta. She also had a high fever about 5 days post-partum,
> but WBC counts were normal. She is visiting OB today to have prolactin
> levels checked and she will inquire about sulpride and nasal oxytocin
> spray. She is currently giving baby donor milk.
>
> We read the Lactnet archives, and it looked like the most recent
> discussion about Sheehan's was from 2007. Is there anything new since
> then? Are we missing anything that would be helpful to this mom?
>
> Thank you in advance for your thoughts and insights.
>
> Warm regards,
>
> Laurie Shornick, PhD, IBCLC, LLL
> St. Louis, MO
>
>
--
Karen Gromada
www.karengromada.com/
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