Kathy Bowers (welcome!) wrote, " Have any
of you read about or cared for moms who received Mag Sulfate during labor
who had erect nipples before labor but flat nipples afterward?  I have a
collegue who tells me that it is ducumented that PIH is seasonal which
would explain why I have seen no less than 6 moms in 2-3 weeks who have
received Mag during labor.  Some of these moms have received Stadol and
all of them have received epidurals.  Even if the baby is awake, rooting
and eager to suck, he often has trouble latching on."

There was a thread about this on Lactnet some time ago Kathy and it has been
in my mind too for the last few days because of a mother I am currently
working with.  Mom of a 3 day old baby called at 7 a m in floods of tears as
baby had been unable to latch since 6 p m the previous evening.  Quick
labour/delivery (3 hours) no meds during preg and only gas during labour (NB
no Mag Sulfate). Baby had been breastfeeding first two days as evidenced by
abraded nipples (!!)  Mom had slightly swollen hands and feet, but the most
edematous breasts I have EVER seen, can only be described as acute, massive,
bilateral engorgement - "wooden". Stretch-marks were bulging ripples (like
seersucker) filled with fluid. Nipples were almost totally obliterated in
hard uncompressible areolas. My  alternate attempts at gentle/moderate
massage of the breasts, pumping or manual expression produced a mere 5 ml
EBM in 2 hours, and after manual expression indentations remained on the
edge of the areolas where my fingers had been.  We tried the baby at the
breast direct (impossible to latch) and with a shield (completely inhibited
letdown).  Nothing was working!  I finally left with recommendations to
continue all/any attempts to drain breasts, use cabbage, eat water-melon
(thanks for that tip, people!) give EBM to baby and small Qx cooled boiled
water for now and arranged follow-ups.  When I phoned the GP she prescribed
furosemide and has since prescribed single doses of bromocriptine for the
next three days and Augmentin.  Two days later breasts are inflamed,
marginally softer, edema is resolving, mom was able to pump 90 ml EBM in the
last 24 hours although now she is so discouraged that she is only pumping 4
times in 24 hours. The breasts are obviously already involuting and I fear
imminent lactation failure, not only as a result of the bromocriptine, but
because drainage has simply not occurred in time. I also dread
mastitis/abscess.  Baby is receiving the EBM and formula for now.

Having noted others' experiences with edema and Mag Sulphate and/or IV
fluids during labour I am now wondering if this kind of scenario is *not* a
result of of the meds/interventions as we thought, but rather a symptom of
pregnancy induced hypertension or some kind of postpartum edema (does it
have another name?)  This case has set me back quite a bit - I am not used
to being so totally ineffective!!  How should this case have been managed?
What should I do next time I see this?  Has anyone else seen such severe
edema when no meds have been involved and would another diuretic be more
effective?  It seems that Kathy's case and mine have similarities, except
for the meds.  All ideas welcome!

Pamela Morrison IBCLC, Zimbabwe (in the middle of Africa, 7/8 of the way
down, bordered - clockwise - by Zambia, Mozambique, South Africa and
Botswana - had to check my map to be sure!!!!)