How interesting.  I had a consult with a mom just a few days ago that had
a six day old infant and she too was dx with cardiomyopathy.  Her "new"
cardiologist recommended that she stop breastfeeding.  She immediately
asked to have me come see her before discharge.  The med she was taking
was an ACE inhibitor, Zestril.  Hales book stated not reviewed by AAP,
but alternative drugs were Captopril  (AAP approved) and Enalapril (AAP
approved).  I gave the mother the information and spoke with the resident
and nurse caring for her.  The resident stated that they were all easily
interchangeable.  She put in a call to the attending.  Well the attending
went nuts about how he was being second guessed by a Lactation
Consultant, "after all he was ONLY a cardiologist!"  Well he did change
the Rx, but he wouldn't talk with the mother and refused to talk to me.
The resident wrote a new script and the mother went home with plans of
breastfeeding and taking the Captopril.
Yesterday I got a phone call from the Home Health Nurse who did the f/u
visit.  She was instructed to go in and help this mother stop
breastfeeding and discuss her CHF (Congestive Heart Failure).  Mom was
beside herself because she had never been told she had CHF.  The Home
Health Nurse phoned me and told me how the mother never heard from the
cardiologist about her dx and the mother was planning on seeing a
different cardiologist and breastfeeding.  I sent a copy of the consult I
had with the pt to the Home Health Nurse.  Fortunately had cc's of
everything in the chart as well (Thank you Tom Hale).  Interesting
coincidence!
LLL Breastfeeding  Answer Book states women with cardiac problems
actually do fine because the prolactin relaxes the smooth muscle and also
helps with blood pressure.  Used the Bibliography for references in the
chart with the consult also.
Mom is breastfeeding, feeling well and on Captopril.  I haven't found out
who she will see as a cardiologist yet, but was unable to reach her
today.  She is determined and I am glad for her.  I can't believe that
the physician would not speak to the patient, a newly dx heart condition.
 Talk about poor bedside manner as well as no concern for the fact that
he was adding extreme stress to a mother with a cardiac problem.  I've
gone on long enough......off the soap box.
Thanks for letting me vent.
Darlene Breed, BSN, RN, IBCLC
Worcester, MA (USA)

On Thu, 17 Dec 1998 21:10:17 -0500 Paul & Kathy Koch <[log in to unmask]>
writes:
>Can anyone explain to me the relationship between birth and subsequent
>heart
>ailments?  I have a newly post-partum mother (6 days) who had a
>planned
>C-sec for back problems.  To the best of my knowledge she has no known
>history of heart problems.
>
>I got a call today from her husband from our local community hospital.
> His
>wife (they are friends from church) was being airlifted via helicopter
>from
>our podunk hospital to a medical center in Wash DC (about 90 minutes
>away).
>He called while he was waiting for the helo to arrive!!
>
>He told me she has fluid around her heart and lungs, an inefficient
>heart,
>fast pulse and low blood pressure.  This is apparently secondary to
>pregnancy/delivery.  The update I got later was a diagnosis of
>cardiomyopathy.
>
>Of course, she has been told that she cannot nurse her baby and she is
>devastated.  Fortunately, our pastor called her shortly after
>admission and
>convinced her to keep pumping anyway (thank goodness for a woman of
>the
>cloth who is a former nursing mother!).  She told Pastor Meredith that
>she
>could be on these meds for 3 months..."Then pump for 3 months" says
>Meredith.
>
>She was told she could nurse her baby "one last time" after they
>arrived
>from the long drive.  I suggested that until we can check the meds
>that she
>not toss the milk and I am hoping to get the list of meds tomorrow.
>My
>hands are a bit tied due to distance but will try to make sure she has
>help
>nearby.
>
>Mostly, I am curious as to what could have contributed to this
>condition.
>Her presenting symptoms in the ER were shortness of breath and nausea.
>
>TIA for any thoughts or suggestions.
>
>Kathy
>
>~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
>Kathy Koch, LLL Leader, BSEd, IBCLC
>Great Mills, MD
>mailto:[log in to unmask]
>"Parents are often so busy with the physical rearing of children that
>they
>miss the glory of parenthood, just as the grandeur of the trees is
>lost when
>raking leaves. ~Marcelene Cox ~
>

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