I seek your collective wisdom.  My client delivered a 31 week gestation
1800g baby girl 6 days ago.  She had a general anaesthetic 4 hours after
delivery and surgery to remove some retained placenta.  I first saw her when
the baby was 2 days old to assist with providing EBM for the baby, who was
receiving formula in the meantime.  The breasts were soft and comfortable.
Manual expression (by me) produced scanty red-brown colostrum from both
breasts (barely enough to cover the bottom of a medicine cup).  The amount
of blood appeared to exceed the amount of colostrum - i e it was not just a
little.  Some nipple pores (on each breast) seemed to produce more blood
than others.  There was no pain.  Mother has valiantly attempted to express
at least seven times each 24 hours and is now producing 2Oml EBM every 3
hours and now feels that a pump is more effective.  The left breast has
today produced milk without blood, the right breast is still producing
blood, although the proportion of blood to milk is much less.

The baby has been cared for by two paeds (one went on holiday), neither of
whom have batted an eye-lid at this red-brown colostrum going into the
nasogastric tube (bless them!, one even encouraged her by saying there would
be "more protein" for the baby).  However the obstetrician told me she has
never heard of this, but if it goes on too long she would like to have it
investigated - she too has gone on holiday and I would like to give some
intelligent info to the locum in the next couple of days.  Would you agree
that the most likely cause of the bleeding is "rusty pipe syndrome" as
described in Lawrence (I have the 2nd edition, p 392-3) and BF and Human
Lactation, p 391-2?  I'm wondering if lactogenesis II has been delayed by
the retained placenta episode, and if the bleeding is simply more noticeable
because of the small quantity of breastmilk being produced at this time.
What do you think?

Mother also asked me a question which I've never had before.  Her blood
group is A-, baby's is A+.  She asks if it matters if the baby has some +
blood.  I said it's likely that the baby will digest the blood so that it
will not matter - is this correct?

Thank you for any thoughts/opinions/experiences with anything similar.

Pamela, Zimbabwe