I'll throw in my 2 cents...here..
According to LLL via BAB 3rd revised edition, Sheehan's Syndrome is an irreversible condition and very rare, causes severe damage to the pituitary gland. Other symptoms include loss of body hair (pubic, underarm) low blood pressure (obviously)..low tolerance for colder temperatures...and atrophy of vaginal tissue...possibly subsequent infertility.....so, maybe look at some of the other symptoms...possibly? Does she have any of them? Just some thoughts..
Hope that helps...
Joy Kahler
LLL of Wyoming, USA
Rachel Myr <[log in to unmask]> wrote:
This is in response to Hope's post, and Nikki's reply to her.
First, I am optimistic that her supply will recover, but it may take a couple of
weeks or more - unless someone had the bright idea of giving her a lactation
suppressant in whatever mix of drugs she was on postoperatively, in which
case all bets are off. Should probably check into this, unfortunately.
This mother had her pph and her second surgery a full week after the
delivery. I presume she had already started breastfeeding and unless there
was significant placental tissue remaining in utero (could have been, if it were
an undiscovered placenta accreta, but rather unlikely since surely they must
have visualized her entire uterine cavity during the CS?), she would have been
into lactogenesis II by then. Sheehan's syndrome is when the pituitary is
subject to hypovolemic anoxia at the time of birth, suffers permanent necrotic
damage and subsequently fails to respond to the hormonal changes post
partum to initiate lactation at all. In my twenty years of midwifery practice
when I have regularly cared for women experiencing blood losses well over two
litres, I have never seen this occur, particularly not if the hemorrhage was
while she was under the direct care of surgeons and anesthetists in an
operating room.
Would it not require computerized tomography to determine whether her
pituitary had become necrotic? Or at the very least, measuring of hormone
levels, and where I live that is not readily available. Consequently, we treat
all cases of low supply based on clinical findings, and effective stimulation
while keeping baby fed are the two absolute necessities. Nikki, how is
Sheehan's diagnosed where you are? And have I misunderstood? Because I
thought it was a permanent condition, precluding milk production entirely. Are
there degrees of Sheehan's and if so, how are they defined?
I think a more likely scenario is that her separation from the baby and the fluid
imbalance resulting from her blood loss at the time of surgery have combined
to allow significant edema which will affect her breasts as well.
Frequent stimulation of the breasts is the most important thing, preferably by
baby, but pumping or hand expression will work if baby is not able to come to
her or not willing to latch. I hope the pump she is given in the hospital is more
effective than the one she obtained herself. Check out the Reverse Pressure
Softening technique, as it is easy to try and may produce results quickly,
increasing milk yields regardless of the method of expression. She could
consider supplementing at the breast so baby stays interested, once they are
together again. If you can get hold of oxytocin nasal spray at an affordable
price (it's cheap over here but requires a prescription!) it wouldn't hurt either.
But I would suspect edema/engorgement causing low yields because of
inelastic breast tissue, until proven otherwise.
She really needs encouragement to be patient and have faith. I recently
worked with a mother whose production looked dismal until a month post
partum, when it finally started to 'happen'. It took her 10 weeks to get there
but she is now exclusively, and very happily, breastfeeding. I learned so much
from that case, and the real take-home message for me was 'keep a long-term
perspective'.
All the best to this mother - I have worked with more mothers than I care to
think about over the last five years who have lost their wombs due to
intractable hemorrhage, and they generally do fine with breastfeeding. They
also have a high threshhold for quitting, because they are so afraid it will be
their only shot at it, esp the primips. Once things get going again, you would
be doing her a favor if you informed her that she would theoretically be able
to breastfeed subsequent children even if she can't give birth to them.
Nobody other than the lactation consultant is likely to tell her that.
Rachel Myr
Kristiansand, Norway
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