G1P1 Mom gives birth to full-termer; she has an extremely rare  placenta
accreta (placenta imbeds "too far" into uterine wall; can trigger
life-threatening, uterus-threatening, non-stop bleeding if placenta is torn
when removed/expelled). Doctors place Mom on Methotrexate, tell her not to
breastfeed, and advise that it is okay to start pumping.  (Hale lists this
drug as L3 for acute use; L5 for prolonged use.)

Mom is sent home *with her placenta still in utero,* to await the action of
the Methotrexate in expelling the placenta, which could take 4-6 weeks, she
is told.

First Q, for me:  is this really what they do these days?  I know that
placenta accreta is no minor matter ...  and the goal here is to save her
uterus.  It just gives me the willies to think that she is going home with a
newborn in arms, and her placenta inside ....

Mom does have a hospital-grade, double-kit pump.  I told her she may not
notice *any* milk at all until the placenta is gone.  She has seen a drop or
two, however.

Second Q:  What regimen of pumping .... if any .... would you suggest for
this Mom?  I'd think the oxytocin-releasing action would help when the
placenta starts to shed.  But I can't imagine that around-the-clock pumping
is wise at this stage.  I don't want Mom to burn out on the task too soon.

Liz Brooks, JD, IBCLC
Wyndmoor, PA, USA




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