Kris

Thanks for giving us a very full history.  I agree with others that
Sheehan's is a possibility.  I've worked with two mothers who had very
severe postpartum haemorrhage who had this - it's never clear at the
beginning, but the situation evolves into this diagnosis simply because no
milk EVER comes in.

Your second post gives us hope.... mom has started pumping 8-10ml 4 times
last night.  This is great.  The appearance of _some_ milk implies that
there is delayed lactogenesis due to postpartum haemorrhage, rather than
Sheehan's, ie that the milk WILL eventually come in.  I've also worked with
several mothers who experienced this where the milk gradually became more
and more plentiful but where formula supplements were absolutely required
until the baby was about six weeks.  So the quantity of milk produced is
very gradual, but it's likely that it WILL come in fully eventually.

The mom needs to keep stimulating and draining the breasts very well (baby,
breast massage and hand-expression, maybe pumping when the milk becomes
more plentiful) hopefully 8 - 10 times a day, and continue with her iron
supplements (and iron-rich foods as you suggest).  The Reglan will maximize
prolactin levels, and help milk production, but when she is satisfied that
the milk _is_ in, she will need to be very very careful to taper this drug
off very very slowly to avoid a sudden plummeting of milk production (as
with any galactogogue).  And finally, the baby is likely to need formula
supplements for possibly several weeks.

Wishing this mother well.  She can have hope, but it will be hard work and
she will need patience. I hope you can give us feedback to let us know what
happens in the end.

Pamela Morrison IBCLC
Rustington, England

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