Dear Fellow Lactnetters,
I need help.... I have a mom who called my last week to rent a pump. Having
trouble with her let down. I delivered her pump and sat down to visit with
her a little about her problem, she had not ask for a consult but I don't feel
it is right just to ignore someone who is having a problem.
Here is the History:
37 y/o gravida 3 her oldest is 12 but she had a son who died about 2 years
ago with Ca. Perfectly normal pregnancy with an easy labor. Baby delivered
fine. When the placenta detached, she went into DIC. Lost approx. 8 liters
of blood. spent at least 10 min with no detectable blood pressure. Recieved
16 units of blood. In the end had to do a hyst to save her life. She says she
woke up 48 hrs. later in ICU on a vent.
Mom very dedicated to breastfeeding. Started pumping as soon as she got off
of the vent. Took 12 days of pumping and nursing to get milk to come in.
After that BF wwent well, good supply, happy baby, good letdown. Baby is
now 4 months old. and her milk will not let down. She says baby will nurse
forever if she is not real hungry but no letdown. If baby is hungry, she has
started to get mad at the breast fussing, butting the breast and does not ever
really seem satisfied from a nursing. Mom rented a dble electric pump from
me to try and help the letdown. Called me last night, she has been pumping
every 2 hrs for sometimes 20 minutes but no consistent letdown. Sometime she
says it will letdown and she will get 3 oz or so pumping after a feeding.
Sometimes letdown in 5-10 minutes then the next time nothing. And apparently
it really is nothing. She either letsdown and has milk or does not get
anything when she is pumping. She has tried brewer's yeast and ginko to
increase supply, peppermint oil for letdown, breast massage, hot packs, deep
breathing, nipple stimulation, shake the breast, skin to skin and nothing
works.
I am calling her OB this morning to see about getting her some oxytocin gtts
compounded and/or reglan. This mom is really dedicated to breastfeeding and is
willing to try anything.
I have several theories about what is going on....
1. Is her body going thru some sort of Post Traumatic Stress?
2. She admits she was not sure she was thru having babies and is somewhat
angry that this decision was "taken" away from her. As well as still grieving
for her son. Is this grief process inhibiting her letdown this much? I have
already suggested she might be ready for some counseling to deal with all she
has been thru.
3. Does losing that much blood and having it replaced by other blood mess up
one's body's ability to produce hormones or the quantity of hormones released?
4. Could it be she has had all of that "other" blood in her system and those
cells have now died off but her bone marrow has not caught up with production
so she is having anemia? No one has checked a CBC on her since d/c from the
hospital, I find that strange.
5. Could it be during the STAT hyst the ovaries got jostled around causing
lots of hormone release in her body and now they have decreased?
This case is a new one for me. Why is she having problems now? I would
think she would have had trouble in the beginning. I have worked with several
moms who lost a whole lot less blood than she did and were never able to
produce milk. Her production after it got started has been great. Now I
really can't tell if production is down because she doesn't have a let down.
I think I will suggest an ac/pc weight check so we can see just how much baby
is getting at the breast.
All Ideas, suggestions and theories welcome.
Kellie Richardson RNC, IBCLC
Lactation Station
Tyler, Texas
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