Also, remember when brain surgery is done and actually almost any surgery where anesthesia is used, medications are given to dry up secretions. Think about how we tell moms not to use pseudoephedrine because it can "dry up" the milk. After brain surgery, patients are given medications to decrease brain swelling, a severe problem, as you might imagine. These medications would probably have an impact on milk production. I used to work in a neuro intensive care many lifetimes ago (before life as an OB nurse, NICU nurse, OB critical care nurse, then migrating to lactation - giving away my age here). I'm rusty on my drugs and I'm sure there have been lots of changes, but the physiology and rationale cannot be all that different now. In the hospital where I work now, we are often called to help moms post-surgeries. Never really seen an engorgement issue, have seen decreased supplies. But these usually bounce back with keeping the prolactin receptors open through stimulation and removal of whatever milk is there by breastfeeding and/or pumping.
-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Pamela Morrison
Sent: Thursday, September 03, 2009 1:19 AM
Subject: When mother is in ICU
Debbie,
I am definitely not an ICU nurse, but I've worked closely with two mothers who had Sheehan's, and I had a client who was exclusively breastfeeding a 4 month old, admitted into the ICU after scheduled brain surgery, who booked me in advance to do hospital consults to help protect/maintain her milk supply.
The two postpartum haemorrhage mothers produced no more than a glisten of breastmilk, ever, in spite of frequent expressing and all efforts to bring in a milk supply. They had been highly motivated to breastfeed (one was an LLL mom who'd breastfed her first baby for over 18 months) so the result was heart-breaking. But primary lactation failure is one of the markers for Sheehan's.
At my first post-op visit to the mother who had had surgery, I went
in expecting a fair degree of breast overfullness. I was amazed to
discover soft, flaccid breasts. I duly taught each shift of ICU staff how to hand-express to prevent engorgement and maintain the milk supply, but there was never any need - it was almost as if the mother's body had abruptly shut down milk production. After 3-4 days the mother was moved to the HDU, and as she gradually recovered from her surgery so her milk supply gradually returned and I was then able to hand-express her milk and, when she was well enough and able to sit up, she took over this task herself. She went home and continued
to breastfeed. If I hadn't seen it, I wouldn't have believed that
this sudden _lack_ of milk after the surgery would have been possible.
The lesson I learned from this (and from another mother who had a very severe car accident also while exclusively nursing a 4-month old and also virtually completely stopped lactating for about a week) is that when there has been severe blood loss and/or trauma, breastmilk production appears to be so negatively affected that there may be no need to pump/express immediately after the crisis; it seems that only as the body is recovering does it slowly "remember" to make milk. So your question may be superfluous. I would think that good postpartum management of your client would include assessment of breastmilk production by examining the breasts daily or twice-daily and attempting to express, to see if Lactogenesis II is imminent. If it is, then expressing/pumping would be good, _if_ the breasts start to fill so as to prevent engorgement/mastitis, adding to her medical
problems. But if there is no milk (as I would suspect) then trying
to stimulate a supply now would not be useful. Actually, it wouldn't impact on the mother's nutritional status because it sounds as if there would be no milk being produced at all. There will be time in the future, as the mother's physical condition improves and her Hb count returns to normal, to see if milk production commences, and if not, then to try and "artificially" induce lactation for the baby. For now, it's sad if the baby has to be fed formula, but it's one of those times when we can be thankful that breastmilk substitutes are available to feed a baby when lactation fails.
Pamela Morrison IBCLC
Rustington, England
-----------------------------------------
I recently had the occasion to be called for a lactation consult for a mother who was in surgical ICU after a severe post partum hemorrhage. Without going into all the details, the mother was intubated on a respirator and heavily sedated, unable to communicate. Putting the issue of the severity of the hemorrhage aside (Sheehan' syndrome, hypovolemia, etc), some of the ICU nurses were concerned with the caloric requirements/ burden that pumping
would put on this patient, that it would delay her healing. I am
not an ICU nurse- adult ICU is WAY beyond my comfort level! - so I am not familar with the nutritional challeges of a critically ill adult. My gut reaction is that pumping would not be that much of a risk to this woman. Even if this woman had suffered a pituitary infarct due to the hemorrhage, I felt that we had an obligation to try to establish a milk supply.
Is there anyone on Lactnet who is familiar with adult ICU situations that might explain this to me? Or, are the ICU nurses making excuses to not pump this mother?
Thank you in advance.
Debbie
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