In a message dated 96-10-17 09:02:59 EDT, you write:

>am working with a mom 25 y/o who had a stroke 1 month pp.  bf was going fine
>untill the stroke.
  This mom is highly motivated.  .  does anyone out
>there think maby relactating is not a good idea for a mom with a stroke and
a
>pacemaker and a replaced valve?
>
>I feel like I am this patients only advocate.  Here is a women with an 8
hour
>a day therapy schedule spending every spare minute she has pumping her
>breasts to make milk for her baby and she is unable to use  the entire right
>side of her body.  she has an entire team of nurses and therapists on her
>case and as I was reviewing the goals for her recovery not one thing is
>mentioned about her goal to relactate for her son.  there is mention in the
>notes of depression and the need to treat with antidepressants if needed.  I
>have explained to the doctor that if she could succeed with this effort I
>believe it would go a long way to help her depression, not to mention the
>natural calming effects of prolactin.  I told this mom tonight how proud she
>should be of herself for her efforts.  Any thoughts, comments,suggestions,
words
>of wisdom and especially prayers would be appreciated.

Jessica,
I know of no reason why this mother should not be allowed and even encouraged
to continue her efforts to relactate.  Medications would of course have to be
evaluated.  My first thought is for you to be honest and discuss with the mom
that her medical professionals are not seeing her efforts to relactate as
even part of her therapy. Tell HER what you told US that it is not even
mentioned in her care plan, but that it CAN be.   SHE is her own biggest
advocate and with all this effort she is putting forth she must also
communicate her needs and desires to her doctor and therapy team to get them
to cooperate and even participate.(plan times during the day for the pumping
just like they schedule the other therapy)  She and her husband are a part of
her rehab team and need to SPEAK UP!   This is a foreign environment to this
couple and they may not know that they can bring this up.   She needs to ask
for her doctor to prescribe your services.  You can help her with assertive
(not agressive) communication techniques . . . help her use "I" messages:  "I
feel terrible that I have lost breastfeeding.  I want to relactate and nurse
my baby again.  Part of my depression and feelings of loss involve my loss of
being able to care for my baby.  This is something I CAN do for my baby and I
need your help.   I would like to be able to resume nursing my baby at least
partly.  I want to ask you to prescribe the services of my LC"   I learned a
long time ago doctors usually respond in a very positive way when a patient
asks for his/her help.  That is the main reason they went into medicine.
   These phrases are just a suggestion of course.  You can talk with her and
write down her words of her feelings.  Help her say what she feels in her own
words.  Help and encourage her to see that she CAN ask her health
professionals(if there is a physhologist or social worker this may be the
best person to approach first) to hear and understand this very important
need of hers.  Also you can inform her that she may be the first nursing
mother they have ever cared for on this unit!   It is NOT that they don't
want to help and be supportive of her relactation, it is that they are
uninformed of the possibility of it, and of its importance to her, and it has
not been part of their routine care.  A lot of mothers see themselves as
pioneers when you tell them this.  Let her know she can help pave the way for
perhaps another mother who may have a nursing baby and be in this hospital or
on this unit.  A lot of good things can happen when you teach people to be
better advocates for themselves.  The best thing would be for the husband to
be with her when she does this.  Then they can say . .  . "We have discussed
this and we would like for you to include my relactation in my rehibilitaiton
plan."  A lot of the staff--the doctors esp. are older (and see themselves as
wiser) than she is.  Presenting a united front with her husband elevates her
position to that of a mature, married woman and mother, not just a pitiful
young woman with a severe medical problem needing their skilled care.

Good luck,
Jane Bradshaw LLLL, RN, BSN, IBCLC
former med/surg nurse & public health nurse (taken care of many stroke
patients)