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 infant 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 interfere 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 function resulting in failure to lactate. Insufficient milk and delayed onset of milk production, consequences of PPH, can have a significant impact on new mothers who often identify low milk supply with failure.
A primipara delivered vaginally a large for gestational age infant who nursed strongly for 25 minutes within the first hour. The mother's initial blood loss of 300 ml and a subsequent bleed of 850 ml 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 the infant was formula fed. When reunited, the infant nursed strongly for 40 minutes but was not satisfied. At this time, a lactation consultant informed mother of the risk of delayed onset of copious milk production. A collaborative team of nurse, patient, and lactation consultant initiated a plan to stimulate the mother's full lactation potential, which eased the mother's anxiety over potential insufficient milk supply. The mother was taught signs of ineffective breastfeeding and delayed milk onset prior to discharge and referred to breastfeeding support resources. The mother noted breast changes at 8 days. At 2 weeks old, the infant regained birth weight, and formula supplementation decreased. At 1 month, the mother elected to use occasional formula, but was feeding the infant at breast to her satisfaction.
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 breast milk feeding. Mothers who experience PPH need nurse champions to support their breastfeeding goals during this precarious time.