Dear wise women of Lactnet,
A few days ago, there was a post on complete lactation failure. I was
just about to post the following, but didn't because I thought that
the responses may be appropriate to the mother I am dealing with also.
The thread doesn't seem to have developed, maybe I can reinstate it so
that we can help both these mothers.

The following is from a letter that the mother gave to me describing
her case


This mum is keen to have another baby and very
motivated to breastfeed. I was wondering whether anyone had come
across this situation before, or had any ideas for further
investigations. We have already suggested a pituitary check, although
she hasn't had this. A complicating fact is that she lives in a remote
aboriginal community and to be flown out for medical investigation
requires some type of crisis. Any investigation she has will probably
need to be at her own initiation and expense.

Her pregnancy was normal and healthy. There were several changes
during her pregnancy as she completed a course of study and moved
interstate. She assures us however that pregnancy agreed with her and
she felt calm and happy.

Her labour was long (45hrs) and intense, ending in a caesarean
section. She was given 3xpethedine, syntosin drip, and an epidural,
topped up for the Caesar.

Baby was put to the breast within 2hr and she was able to comfortably
feed lying down over the next couple of days. She had a good recovery
and was able to move around without much pain. Progressed to feeding
sitting in a chair with baby on a pillow by day 3. Baby attached well,
sucked well and mother had no sore nipples. Colostrum was evident and
she mentioned that it is still there now
(baby is 11m old - is this a 'red flag')

Day 5, with the OK of hospital staff she contacted a breastfeeding
counsellor as milk had not 'come in' baby had lost 10% of birthweight,
her wet nappy count was down and she had a 'weak cry'. Management at
this time was to give baby 20ml/3hrly of formula via supply line. This
was to ensure that baby would stimulate the breast and feed frequently
enough.

It was considered that she may have low prolactin levels and Maxolon
was prescribed. It was explained that Maxolon would increase prolactin
levels and has a window of opportunity of the first month of
lactation. At 6 weeks her levels were checked and they were 'normal
for someone not breastfeeding'

Mother and baby went home after 1 week, hopeful that in a home
environment, her milk would come in. For the next month, she fed with
the supply line and took Maxolon. Every time she fed with the supply
line, she felt reminded that her breasts were not working and after 1
month, felt that it was "time to move on" and baby was weaned to
bottle feedings.

"My labour obviously didn't turn out as I would have hoped, but I knew
that the doctors and I had done all that could have been done and that
the caesar was the only sure way of a healthy outcome. I had no
regrets about the labour, however when I had problems with my milk
coming in, I felt I had been served a double whammy. I didn't feel
like a mother, couldn't deliver a baby and now couldn't feed on
either. I felt as though I might as well have adopted her."

"We hope to have another child and if this happens again I'm sure I
will find it difficult, but I now realise that the most important
thing I can give my children is not my breast milk but my love, and
that is one thing that is not beyond my control."

OK - any thoughts about this situation?
Her breasts are well developed and look 'normal'
Is it possible that her 'easy' pregnancy and difficult labour
may be a sign that hormonal activity was compromised to start with?
Also the lack of nipple soreness in the first days? Is the fact that
she can still express a colostrum like fluid a red flag also for an
endocrine problem? Should she have a thyroid test?
It was considered that retained placental fragment wasn't a problem
due to the caesar (??)
What would you suggest?

thanks in advance for any help
Querida


Querida David
Alyangula, NT. Australia
NMAA Counsellor, NT
Editor 'Upfront' NT Publications review team
Email: [log in to unmask]