Jane - My goodness!  A Eureka moment!  What a fascinating explanation 
for the abrupt suspension of lactation I've seen.  Thank you so 
much!  Am trying to remember the circumstances of other mothers - one 
who had emergency surgery for bowel obstruction (no apparent effect 
on lactation), and another whose milk had already come in very well, 
had post-partum psychosis at 9 days, hospitalized and put on a drip 
with very high doses of chlorpromazine, and again, appeared to suffer 
abrupt lactation failure, soft breasts, no need to pump/express, her 
family took over complete care of the baby who was never breastfed 
again.  Then, as I said, I've worked with two mothers who suffered 
such severe post-partum haemorrhage that they were eventually 
diagnosed with Sheehan's.  But there were others where the HB count 
was very low (blood transfusions were almost never given in Zimbabwe) 
and lactogenesis was effectively delayed but eventually came in 
slowly - one not until about six weeks postpartum, but the mothers 
kept up efforts to bring in the milk, and went on to exclusively 
breastfeed from that point.

I guess all we can conclude is that there could be a very 
individualized response or effect on lactation to PPH, trauma, and 
the drugs used to treat the mother.  But you've given an answer to 
one piece of the puzzle :-)

Gratefully

Pamela
---------------------------------
Date:    Thu, 3 Sep 2009 10:24:03 -0500
From:    Kershaw Jane <[log in to unmask]>
Subject: Re: When mother is in ICU

Also, remember when brain surgery is done and actually almost any surgery w=
here 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 neur=
o 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.  B=
ut these usually bounce back with keeping the prolactin receptors open thro=
ugh stimulation and removal of whatever milk is there by breastfeeding and/=
or pumping.

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