Loss of Blood = Loss of Breast Milk? The Effect of Postpartum Hemorrhage On Breastfeeding Success
Title: Loss of Blood = Loss of Breast Milk? The Effect of Postpartum Hemorrhage On Breastfeeding Success
- List the factors brought about by postpartum hemorrhage which impact breastfeeding success.
- Describe interventions to promote breastmilk production and breastfeeding success for a mother who has experienced a postpartum hemorrhage.
- Understand the emotional impact of postpartum hemorrhage on breastfeeding and its importance, even in the midst of a life threatening complication.
Postpartum hemorrhage (PPH) can trigger a series of events that prevent a mother from fully breastfeeding. Routine evidence-based actions to increase breastfeeding success become interrupted. Mother and baby may be separated, causing a delay in breastfeeding initiation. Maternal fatigue may also necessitate formula supplementation. A traumatic birth and maternal stress and fatigue associated with PPH often interferes with the normal onset of Lactogenesis II. Blood loss and hypotension may cause ischemia or infarct of the highly vascular pituitary gland. During Lactogenesis II, prolactin which stimulates human milk production, releases from the anterior pituitary. Following pituitary insult, altered prolactin levels likely cause insufficient milk production. In the rare complication of Sheehan’s Syndrome, the necrotic pituitary completely loses its function resulting in the failure to lactate. Insufficient milk and delayed onset of milk production, consequences of PPH, can make a significant impact on new mothers who often identify low milk supply as a sense of failure.
Case:
A primapara delivered vaginally a LGA baby who nursed strongly for 25 minutes within the first hour. Initial maternal blood loss of 300 milliliters and a subsequent bleed of 850 milliliters caused her hemoglobin to drop from 12.6 mg/dl to 6.8 mg/dl. She was transferred to a high-risk unit and transfused. Breastfeeding was interrupted for the next 22.5 hours while her separated baby was formula fed. When reunited, baby nursed strongly for forty minutes, but was not satisfied. At this time, a lactation consultant informed mother of the risk of delayed onset of copious milk production. A collaboration of nurse, patient and lactation consultant produced a plan to stimulate the mother’s full lactation potential. A feeding plan for baby eased the mother’s anxiety over potential insufficient milk. The mother was taught signs of ineffective breastfeeding and delayed milk onset prior to discharge and referred to breastfeeding support resources. Mother noted breast changes at eight days. At two weeks old, baby regained birth weight and formula supplementation decreased. At one month, mother elected to use occasional formula, but was feeding baby at breast to her satisfaction.
Conclusion:
Nurses can collaborate to offer appropriate practical and emotional breastfeeding support for mothers experiencing PPH. Even when full breastfeeding is not attained immediately, evidence supports the possibility of transitioning from partial to full breastmilk feeding. Mothers who experience PPH need nurse champions to support their breastfeeding goals during this precarious time.
Keywords: postpartum hemorrhage, delayed lactogenesis II, insufficient milk supply