Jaye

Hmmm, this sounds dire.  I've worked with a mother who had a 5-hour 
brain surgery for an aneurysm at the base of the brain and she booked 
me in advance for consultations in the hospital after her surgery, 
specifically to take care of her milk supply.  She had a 4-month old 
exclusively breastfed baby who was going to be cared for (and 
formula-fed) by the extended family at home while mom was in the 
hospital (about 300 km away) and she definitely wanted to resume 
breastfeeding afterwards.  She had intended to breastfeed up until 
the last minute, and I had recommended that if she was able to keep 
the breasts well drained while separated from her baby, that this 
would be the best thing that could happen..  Luckily I was able to do 
consults in the maternity unit of the hospital already, but the 
mother cleared my visits in advance with her surgeon and nursing 
staff in the ICU and it was arranged that I would do hospital visits 
twice a day and show the staff how to care for her breasts.

I went in to the ICU on the morning after her surgery, armed with a 
manual cylinder breast pump (this was Zimbabwe ...) and expecting to 
find pretty hefty breast engorgement.  Mother was flat on her back, 
hooked up to tubes and monitors (I'm not a nurse!) and appeared to be 
completely unconscious.  A breast exam revealed the most amazing 
thing - the breasts were soft, comfortable and barely lactating at 
all.  Nevertheless for the next three days I visited each morning and 
afternoon, and showed the staff how to manually express my client's 
breasts just in case.... but the breasts remained soft and 
flaccid.  I hated working with an unconscious mother, but I talked to 
her as if she was awake and well, and later she told me she heard 
every word I said, and really appreciated it!

On the fourth day the mom was well enough to be moved to the HDU and 
was able to talk and have some pillows.  The fascinating thing for me 
was that as her condition improved, so her milk supply started to 
return.  The pump was not necessary at this stage, and difficult to 
use on a supine mother, and the breasts were still soft and 
comfortable but I was able hand-express for her and I recall a jet of 
milk going up over the curtain rail round the bed.  It was a relief 
to see some milk, and the timing seemed to be so good - no milk while 
she was so critical and then returning as she recovered.  By the 
following day the mother was well enough to start using the pump by 
herself, and then she took over, pumping about every 3 hours while 
she was awake.  She did resume breastfeeding once she got home, and 
took sulpiride as a galactogogue with the endorsement of her surgeon, 
so everything turned out exactly as planned.

But again, as I say, the complete lactation failure as a result of 
the surgery took me completely by surprise, almost as if Nature has a 
built-in safety mechanism. I've only ever seen that happen twice 
again - once with a mother who had had a really bad car 
accident.  And once again, milk production started coming back as the 
mother's physical condition improved (baby was 3 months and also 
exclusively breastfed).  The second time was when one of my clients 
was hospitalized with postpartum psychosis at 9 days and was sedated 
with such high doses of chlorpromazine that she was virtually 
comatose - again the milk just vanished.

The situation of your client, Jaye, sounds much more difficult than 
the above.  It could well be that she has increased her milk supply 
by trying to stockpile milk in advance of her surgery.  But whether 
she should attempt to suppress lactation before the surgery for the 
convenience of others, if this was my client, I'd think NOT!  There's 
always the chance that Nature will take its course, as it clearly did 
with my clients.  And if not, the hospital and the doctors are there 
to serve her, not the other way around!   In addition, the sharp drop 
in prolactin levels which happen with abrupt weaning, would surely 
exacerbate the depression she must be feeling already at the thought 
of being so ill, and facing such surgery, as well as separation and 
worry about her baby.  Bravo to her husband for his willingness to 
help - what a gift!  Perhaps a little assertiveness at this point to 
specify what he and his wife want, rather than what they will be 
"allowed" wouldn't come amiss??  What I would suggest though is that 
you teach him in advance how to hand express for the mom.  It's not 
difficult, and might be infinitely easier to accomplish (and gentler 
...) than pumping with an unconscious or semi-conscious wife.  And he 
could maybe teach the staff what to do when he's not there.  Whether 
the milk - if any - could be caught in a bowl, I don't know, but if 
not I'd focus on keeping the breasts well drained and just catching 
the milk in a towel.  Would it be possible for you to do hospital 
consults for this mom, and/or contact the surgeon in advance in order 
to be acknowledged as one of the healthcare team in this very special 
situation?  There's a whole mother, and a baby here, not just a brain 
tumour, and I'd think everyone would benefit from thinking holistically.

Best wishes.  Would love to hear how this turns out Jaye, if you're 
able to give us feedback.

Pamela Morrison IBCLC
-------------------------------
Date:    Fri, 25 Apr 2008 10:55:05 -0700
From:    "Jaye Simpson, IBCLC" <[log in to unmask]>
Subject: Brain tumor surgery - need info asap

I have a complicated situation that I need information on ASAP.



Mom has 5 month old baby is breastfeeding exclusively.  3 wks ago she
developed a severe headache and had issues with swallowing.  She was
subsequently diagnosed with 2 brain tumors.  They are on the left side of
her brain - one pushing on the cerebellum the other anterior to the left
styloid process.  (hope my spelling is correct)  The Neuro says they are
either Schwannoma or Glomus Vagale tumors - they aren't sure.



She is scheduled for a minimum 10 hour surgery on May 13th.  I gave her a
contact number for the LC on staff there in hopes she can also help this mom
and I will be in contact with that LC as well.  Drs have told her to wean
immediately as they will have no one to pump her and are not sure how her
recovery will progress.  Mom does NOT want to wean, and if she must lower
the supply wants to be able to bring it back up again.  She has had a
successful 5 months of breastfeeding with a stable supply.



Questions:  Should she wean the breasts down - and if so what is the safest
way for her to do this and quickly?  With brain tumors I am not sure if sage
and pseudoephedrine are safe.  She has been pumping extra milk for her baby
the past week or so in an attempt to not have to use formula.obviously this
is going to increase the supply.  I already told her how to drop the supply
without using any other means other than spacing out feeds and no longer
pumping - but I doubt she will be weaned enough by surgery time to make
pumping unnecessary.  Her husband is willing to pump for her while she is in
recovery - but she is not sure that will be allowed (she has a list of
questions to ask).  She is also unsure of how her recovery will go.



If she does drop the supply down what would be safe for her to take after
recovery to bring it back up?  Would herbs be safe??  Obviously I am not
qualified to answer these questions.



Help!  Any thoughts and input are greatly appreciated.



Jaye Simpson, IBCLC, CIIM

Breastfeeding Network

Sacramento, CA

www.breastfeedingnetwork.net

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