HI Everyone,
Just wanted to share a recent case and pick all your brains.
A first time Mom in her early 30's delivered a healthy 36 weeker vis
C-section and was found to have an accreta.  The options were discussed with
this Mom and she choice to keep her uterus and receive antibiotics and
Methotrexate (Rheumatrex).
Before she started on the Methotrexate we worked with her to try and
breastfeed.  The baby boy did not latch well.  The Mom was started pumping
but did not obtain more than drops on days 2&3.  I discussed the use of an
SNS but she got transferred to a larger hospital to start on the Methotrexate
and the last I heard she opted to just stop.
With this treatment plan the Mom has a couple weeks on the antibotics and one
week on the Methotrexate.  She is sent home to observe for increase bleeding
and infection.  In 6 months they bring her back to the hospital to do a D&C
when the uterine wall is thicker.
Now with this plan there is basically retained placenta tissue so
Lactogenisis II cannot occur.  Would people agree that an SNS is an
appropriate option?  Does a Mom with this course have to pump and dump while
on the Methotrexate since only a small amount of her milk is the baby's diet?
Thankfully accretes are rare but if more Moms go to this choice of treatment
how should we as LC's be prepared to support them with breastfeeding?
Thanks for any feedback.
Ann Perry RN IBCLC
Boston, MA

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