I am sorry to send such a long post...I really try to avoid sending
anything over a couple of paragraphs but....this midwife has asked that
I post to the great lactnet minds regarding this very difficult case.
She would appreciate any help you can give. Send responses to me
provately (and to the list if appropriate).

Thanks

Susan>



Dear Midwives;  I have a client who gave birth about 8 weeks ago.
> > This was her third child.  I assisted her with both of her other
> > children.  Her first child (now 4 yrs old) was born by c-section
after
> > a two day home labor with failure to descend.  At the hospital, they

> > also tried to deliver with both forceps and vac-extractor, unable to

> > bring head down into position, so they operated.Second baby, (now 2
> > yrs. old) was born at home like butter.  About a month after she was

> > born, the mother went into a severe case of postpartum depression
> > (actually, it may be called puerperal hypomania) which led her to
> > completely disrobe and run through the street of her small town with

> > nothing but a towel wrapped around her head and jump into the river.

> > She swam into the middle of this river and was rescued about an hour

> > later.  She was hospitalized for 6 days and released in a condition
> > which I felt was not yet safe. (She still believed that she could
see
> > the spirits, including Jesus around us, etc.) She refused to take
the
> > meds that had been prescribed for her and she did this because she
> > wanted to breastfeed and had been told that she could not because of

> > the meds.  I feel like she did not completely recover from her
illness
> > for many months.  Her mother said it was more like a year.  She has
> > now had a repeat.  She had made a phone call to her friend and had
> > displayed the same kind of irrational talking so her friend had
> > another person go and check on her.  They found her in a sort of
> > catatonic state sitting against the wall and mumbling gibberish.
the
> > children were running naked in the house and the four year old told
> > the person that they were hungry.  She (the neighbor) made the kids
a
> > meal and called the husband to come home right away.  When he got
> > there, she got violent and the police were called.  That night, he
> > (the husband) called me and others to say that he was helping his
wife
> > to call all of their friends to "say goodbye" because she was  going

> > to the spirit world and not coming back.  I begged him to call the
> > police or take her to the hospital right away.  He seemed to be
going
> > "off" with her, but I guess he was just going along with her to keep

> > her calm and he was trying his best to do some kind of "therapy" by
> > himself for her.  Anyway, the next day, he did take her to the
> > hospital and she has been there now for about two weeks.  We have
> > taken the baby to a nursing mother (the same dear woman who fed the
> > last baby last time) to be breast fed while she is in the hospital.
I
> > have been helping to care for the two older ones and we are all
coping
> > with the situation as best we can.I believe that the woman is
fighting
> > the doctors regarding her medication.  She wants to continue to
> > breastfeed her baby after she is out.  They say she can't because
the
> > drugs are not safe.  She hates the idea of the meds anyway, saying
she
> > is just depressed, not psychotic. The drug they are giving her is
> > Haldol.I think we should bottle feed the baby.  If we do that, then
> > she won't be taking a pristine breastfed baby and bottle-feeding it
> > (she is really committed to breastfeeding) the baby will have
already
> > become a bottle-fed baby.  My reasoning is this.  Of all the choices

> > in a ideal world, the best thing is for the baby to be breastfed by
> > its' mother.  Since we are not in that ideal world yet, I think it
> > would be better to have the children be back with their mom and dad
> > with the mom on her meds and bottle-feeding the baby rather than the

> > way it is now.  I do not think the doctors are going to let her go
> > until she agrees to take the meds.I have also looked up the medicine

> > in the "medicines and Mothers' Milk" 1998-99 edition and it says
> > "effect on nursing infant is unknown but may be of concern".  It
goes
> > on to say under "pediatric concerns:  None reported via milk, but
> > caution is recommended.  Observe for sedation, weakness."This baby
is
> > taking a form of levothroxine (thyroxine, I think) which has a
caution
> > about drug interaction with tricyclic antidepressants saying that it

> > may increase toxicity.Can anyone advise me whether we should help
her
> > fight the fight to continue breastfeeding under these conditions?Is
> > the drug therapy really that dangerous to the baby (more dangerous
> > than the complications which may result from the formula?)What about

> > the combination of the two drugs?Should we get that baby off the
> > breast and on the bottle in order to help the mom feel less like SHE

> > is doing it?A lot of well intentioned dreams are being dashed here
and
> > a very wonderful family is suffering from the many facets of this
> > problem.  I would be so grateful for sage advise from the
> > midwives.Thank you,  & love,Alice Skenandore

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