I would love some input on a scenario I have not dealt with before.  We have 
a mom, day 10 postpartum who until yesterday was in ICU.  At 35 weeks she 
had an abruptio of a grade 3 placenta praevia/acreta.  Baby fine, but mom 
had major bleed about 4 hours post caesarean - we almost lost her.  She 
returned to theatre for a hysterectomy and repair of bladder.  She was 
ventilated for several days and I managed to get expressing/pumping started 
about day 5.  Her breasts were soft at this stage.   Even though I had 
warned the ICU staff that I didn't expect much volume, I stressed the 
importance of frequent pumping.  This they did.  However, with a change of 
staff  I guess someone decided that the few drops that were obtained were 
not worth the effort so stopped over the weekend.  Her doctors assumed that 
the medications she was on were not safe for breastfeeding, but the 
paediatrician checked in Hale and found that they were!  (A major 
breakthrough!)

Today, mom is back on the postpartum ward and baby has hardly left her arms. 
She so wants to breastfeed and baby has been on the breast very frequently 
all day and topped up with cup feeds per  doctors orders.  She does have 
colostrum  - more than a few drops now.

With a massive bleed like this and its possible effect on the pituitary I 
expected delayed lactogenisis.  I am hopeful that we will achieve full 
breastfeeding within a day or two.  Is this realistic?

Jean Ridler  RN  RM  IBCLC   (Hospital and Private practice)
South Africa   [log in to unmask] 

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