Dear Lactnet,
    Like Jeanette's SIL, I have had 3 patients in the last 6 weeks presenting
with low milk supply who later had diagnosed retained placenta and subsequent
D & Cs.  The range of discovery was 5 days, 12 days and 3 weeks.
    In each case it was a suspicion of mine and I urged the mom to discuss
the possibility with her HCP.  I have had several cases of this before and
sometimes I see a watery milk pumped, fleeting if no overt engorgement, and
no change in supply with herbs, Reglan or Domperidone or extra pumping with a
hospital grade pump. They all ended up passing clots eventually but no
presenting fever or pain but in 2 cases I have seen.
    One of the above moms had carried triplets and lost two of the babies at
18 weeks.  Two were c-sections.  Only one has recovered her supply.
    Since these all came bunched together I thought I was overimagining the
likelihood of it in each mom.  In two of the cases they started the moms on
Methergine but out-patient D & C was later performed.
    I have begun faxing the OB/GYN or midwife a report of the low supply
issues.  Usually I only send the fax to the ped unless it directly affects
mom (yeast, mastitis, etc).  In the above cases I had written to the HCP
about a possible link (whew!).
    One way I suggest the mom approach the topic with the HCP office when
getting an appointment is to explain the hesitancy of the doctor to consider
the diagnosis with no fever, clotting or cramping.  I say,"They do not like
to consider a placental fragment.  Many of them act like you are suggesting
they left a SPONGE inside you when actually it can be microscopic."  This way
they get the mindset of the diagnosis.
    Over the years I have had 4 sets of twins with retained placenta and
overwhelmingly c-sections.  And who knows how many undiagnosed?

Jan Ellen Brown IBCLC
In rainy Charlotte, NC USA

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