Calling all midwives, OB's, OB nurses or anyone with any insight on the
following. A little bit of history first.
I am working with a mother now 1 month post partum. She is producing about
12 oz. milk per day. Initially mom thought baby was breastfeeding well, but
he did not gain well. On test wt. in the office at around 2 weeks, he got
about 20 ml total. Mom pumped after for a total of 10 ml more. Estimated
milk supply at that time was approximately 8 oz. per 24 hr. Baby had a
strong, coordinated suck on digital exam and no abnormalities of the oral
cavity were noted. Mom went home with a plan to breastfeed on cue with breast
compression and switch nursing to enhance milk transfer, pumping after,
supplementation by SNS. SNS did not work well and baby became frustrated at
the breast so mother, who is totally dedicated to providing her baby with
breast milk, began pumping with a hospital grade pump 8+ time per day and
supplementing pumped milk and formula by bottle. Breasts look normal--are
not widely spaced, tubular or hypoplastic appearing. She does not think she
had any breast growth during the pregnancy (her first), however. She has no
hx of thyroid problems. When I saw her at 2 weeks she still had some bright
red bleeding, maybe a pad or two per day. I discussed the risk factor of
retained placenta but over the next couple of days the bleeding subsided.
Milk supply did not increase beyond 12 oz. per 24 hr. so she obtained
Domperidone about a week ago. Meanwhile she started to have bright red
vaginal bleeding again--about the same amount as during a normal period for
her. She still continued to pump 8 or more times per day, but despite
Domperidone milk supply dropped a bit. The nurse in her OB's office told her
that we had given her totally false info re retained placenta and low supply.
I called the nurse back and told her that I could provide her references if
she would like and asked to speak to the OB. She did not put me through to
the doctor but instead told me that the OB would call the mom. The OB told
the mother that she did not have retained placenta because she has no signs
of infection. When the mom asked if she had started her period (the OB
nurse's explanation) the OB said probably not but offered no explanation for
the bleeding.
To complicate matters a bit more the baby has been readmitted with RSV
(Respiratory Synsictial Virus) and, of course, mom is quite stressed. She is
still having a small amount of bright red bleeding.
So to finally get to my question-- if this is not retained placental
fragments and it is not a period, what is it? I would like to at least rule
out retained placenta so I could reassure this mother she has done all she
could to increase supply. How common is it to have bright red vaginal
bleeding at one month post partum? Mom is planning on seeking a second
opinion from another OB as soon as she can.
Thank you for any help you can give me on this.
Kathy Boggs, RN, IBCLC
Mountain View, CA
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