In a message dated 7/29/2003 11:42:12 AM Eastern Standard Time, [log in to unmask] writes:

> I was contacted by ICU staff this morning with a question I don't quite
> know how to answer. Any thoughts on this are appreciated, and are most
> urgent:
>
> Mom has a one-week old infant at home. Mom was admitted yesterday to
> ICU for an intracranial bleed into her ventricles which is life
> threatening. Her doctor said she had to stop breastfeeding because
> pumping her breasts would cause increased pressure in the brain. The
> dedicated nurses on staff disagreed, and told the physician that the
> mother would lose all of her milk if she didn't pump, and they have
> carefully been pumping her breasts every three hours with LOTS of
> concern that they may be doing the mother more harm than good.
>

Can the ICU nurse ask the physician for research to support the alleged increase in pressure? Obviously, both want to provide evidence-based care as able.

I'm wondering how engorgement and/or mastitis from abruptly halting milk removal with resulting milk stasis would do for her condition, including concern about agitation/movement? Would think that couldn't help IC pressure. (Sometimes docs, esp. non-OB-related types, forget lactating breasts aren't just faucets one can turn off and don't think about consequences of stasis.)


>
> The staff called this morning to ask me if they could pump her breasts
> less frequently and still maintain an adequate milk supply for the
> mother. Evidently, the less this mother is disrupted for pumipng, the
> belief is that her brain will be less traumatized. My response was that
> I could not promise the supply would be adequate if the mother pumps
> less than 100 minutes per day.
>


Sometimes we have to compromise "ideal" for some period to accommodate a physical complication in a mother or infant. If decreasing the number of sessions or total minutes helps in this mom's recovery, it may (or may not) be necessary for now. (I'm not making a recommendation -- only throwing out thoughts.) We've had MOT/MOM who AFTER decent establishment of lactation have had complications that resulted in less milk emptying than ideal. Most were able to increase again with increased BF or pumping once able to resume ADL.

Good luck and please keep us posted...

Karen G

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