# Does postpartum hemorrhage/Hemabate affect milk coming in?



## Momsteader (Dec 13, 2002)

I delivered twins vaginally 3 days ago and my milk still isn't in. I know it's not unusual for it to take a bit, but this is delivery #4 for me and my milk has always come in 24-36 hours later, so I assumed with twice the stimulation it wouldn't take longer.

I'm wondering if having had a postpartum hemorrhage and being given several meds including Hemabate to finally get it under control would affect when my milk comes in?

I'm pumping mostly (which I've done early on each time) and I know that the pumping isn't the reason. Nursed the babes for most of the first 48 hours so got a good start on stimulation. (It's a surrogacy.) And, I'll nurse them several times a day for the next few days as well.

Pumping every 2 hrs for 30 mins and I'm getting about 1/2 oz total of mostly colostrum, though there is initially a little spraying like my milk is in a little. No fullness or warm feeling of milk being 'in' yet though.

Any ideas?


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## MonkeysRUs (Jun 1, 2007)

How wonderful that you're acting as a surrogate.







Postpartum hemorrhage is definitely a risk factor for delayed lactogenesis II (your milk coming in), and possibly issues with milk supply if the hemorrhage was severe enough. You might want to contact an IBCLC if your milk doesn't come in soon. Are you going to be pumping for the twins?


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## ~Heyokha~ (Nov 21, 2006)

nak

I hemorrhaged with dd2, my hemoglobin dropped to 6.7 post partum. my milk was late coming in (hard to remember but I think day 4-5???) I initially had low supply and dd was loosing wt. My MW had me on floradix 3xs daily, drinking lots of fluids and eating high protein. I pumped in between nursing and within 1-2 weeks everything was ok. Good luck mama!!


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## Momsteader (Dec 13, 2002)

We saw an IBCLC in the hospital before discharge. Mom is inducing lactation (again yay!). She induced lactation for the little girl I carried for them in 2005 and nursed her until 13 months! I pumped for 13 weeks and sent for supplement for her until mom's supply was enough. I did call the LC again to ask specifically about my milk not coming in yet. We were only about 36 hrs out when I saw her and she said it was fine. I know it can take up to 5 days, but just getting a little worried as it's different than my 'usual'.

I was planning on pumping this time as well, and normally am a 'super pumper'--20-25 oz a day within a week or so of birth and then 65-70 oz a day from about 2 weeks out, so this is really odd for me not to just have lots of milk right away.


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## Morwenna (Oct 17, 2003)

holly, I'm having nursing and supply issues too, and usually have a total overabundance of milk. I also lost a LOT of blood this time too--wondered if it's related? How does one build up the milk supply? I'm feeling totally stressed (I know that doesn't help) and I am pumping too and not getting much at once (lucky if 1-2oz). Baby seems hungry and I am at a loss as to what to do...I also have horrific nipple pain (normal for me, but it's pretty much intolerable at this point but I don't seem to be able to pump enough)....help?







:


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## Electra375 (Oct 2, 2002)

I hemmoraged this time around too (other 3 did not). What I've learned unrelated to milk supply is that hemmorage can damage your pituitary gland and thus affect your thyroid, but not be detectable on the standard TSH thyroid tests. I know my pituitary is affected by reading about it, I have yet to find a medical tests that proves what I know that a doctor will run for me. Which is very frustrating...

I had supply issues in the beginning b/c it wasn't until ds was 8 days old that I discovered he was tongue tied. I had his tongue clipped and my milk came in in full force 2 days later.

PS - I did find a chiropractor who can tell me that my thyroid, pituitary and hormones are all out -- it was rather amazing. Maybe he will help me, even if it isn't covered by medical insurance. At this point, I'll try anything...


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## Rebecca (Dec 4, 2002)

Holly, I have no suggestions but wanted to offer a huge hug and all my support. I miss not chatting with you in practically forever!


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## Momsteader (Dec 13, 2002)

Morwenna, I wonder if the nursing AND pumping is aggravating the nipple pain? I feel for you mama! In researching and reading I see that only pumping 1-2 oz a session is NOT bad! To get a lot you have to really build when pumping and exclusive pumpers usually get more than occasional pumpers, because they are used to doing it and responding to the pump instead of baby. Have you asked your MW about it? I'd be interested in hearing if she thinks there is a link!

I have a chiro appt on Monday and I'll ask him about it. He's a wellness chiro and usually has the scoop on natural things or can find out for me.

Thanks Rebecca! You should e-mail or PM me through here. I've wondered how you are lately!! Or, if you see me on MSN buzz me









So perhaps there is some kind of 'link' with hemmorhage and milk supply issues. Or at least I'm not totally alone! I've also read that there is a link with pitocin and slow milk coming in, and I had a ton of pitocin post birth as well as the first step in trying to control the bleeding. I had the 'max'. All I remember the nurse saying was something about the 'whole bag' and that she'd ordered 'mether'something' next and it would be there. I need to get a copy of my birth record and see exactly what all I was given.

I went and nursed babies non-stop for about 2.5 hours tonight, and when I went to leave one was crying and I got a little 'tingle' so maybe the milk is coming soon. Still no heaviness or heat like milk is coming in though. I'll have two or three more marathon nursings before they go and hopefully I'll be reporting oversupply soon! LOL


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## narcheska (Jul 27, 2007)

I also hemorrhaged and was given a couple of shots of who knows what which made me sky high for a couple of days. My baby was whisked off to SCBU a couple of hours after her birth due to breathing difficulties which were detected during our second attempt at breastfeeding. I was lucky enough to have her back in the ward with me about 18 hours later, and breastfeeding resumed. My milk came in on day 5 or 6. I thought that was about normal!


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## Momsteader (Dec 13, 2002)

Narcheska, I didn't feel 'high' after mine. Very flu-ish though.

Well, I am getting *a little* now that looks like milk, but still no 'milk coming in must feed a baby NOW' engorgement type feeling that I've always had. But, a little milk is GOOD!


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## RootSnort (Nov 22, 2006)

I know what happened. They gave you Methylergonovine, and that can interfere with prolactin and delay milk letdown and keep your supply low at first.

http://toxnet.nlm.nih.gov/cgi-bin/si...temp/~7dxOB6:1

I looked over at Lactmed, and it says that if you got a shot, it's a bigger hit. You can also take it as a pill.

My advice would be to get reglan or Domperidone for the first month or two so that you can bring your prolactin levels back up and help you become a fountain of milk!

Good luck and keep us posted!


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## narcheska (Jul 27, 2007)

Stay positive and think over and over again 'I have buckets of milk!' Mind over matter. You'll get there. Such an amazing thing you are doing. Just awesome.


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## Momsteader (Dec 13, 2002)

Thanks Laura. I did get the injection form on all three meds.

I 'doubled' what I was pumping two days ago. Yay! Up to 10 ounces in a day. And, feeling a slight 'full' achy feeling between pumpings. I'm trying to do every 2 hrs for 30 mins around the clock for the next few days to see if that will jump start me. Added herbs and am eating lots of oatmeal.

Does anyone have links to good info on Reglan/Dom? My hubby said he'd rather me not take more 'drugs' as he's worried about adding something to counteract the effects of another drug. So, I'd like to read a little and see.


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## RootSnort (Nov 22, 2006)

There is tons of good information here:
http://www.mothering.com/discussions...d.php?t=461626

It is likely that you will be able to overcome the meds and do this all by yourself. I forgot that it's only been 3 days. You've come a long way in just one day!


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## Momsteader (Dec 13, 2002)

Thank you for the link Laura! Looks like I'm at 10.5 ounces for the last 24 hours. Still so frustrating







By a week PP with all my other pregnancies I was pumping copious amounts and had full engorged breasts before every pumping. My breasts feel like I've been nursign for months and no 'hardness' between feedings or 'softening' after pumping.


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## RootSnort (Nov 22, 2006)

Baby's tummy is small right now. See how you're doing in a few more days as that stuff gets out of your system. And keep us posted!


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## Momsteader (Dec 13, 2002)

They're taking a total of 10-14 ounces each a day of supplement right now







I feel so bad!! Last time, surro-daughter had only a few ounces of formula initally as I had enough for her. IM's milk is coming in though as they are having more breastfed baby looking BM's.

I managed to connect tonight with a local gal who was done nursing and had extra Dom, so I have that now if needed. And, I upped my herbs some per the LC.


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## RootSnort (Nov 22, 2006)

They're still getting lots of benefits from the milk they are getting. If you arent producing as muhc as you want at 7 days post-partum, I'd consider the domperidone. You'd probaby need in for only a month or two.


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## Momsteader (Dec 13, 2002)

Started the Dom today. Hoping to see some improvement by next week! I have enough for about 90 days. Hoping I won't need it that long, but I have it just in case. Thanks for all the encouragement.


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## Momsteader (Dec 13, 2002)

Up to 12 ounces for 24 hours now. Still not much







But it is slowly increasing! Still no 'let down' type feelings and no engorgement or feeling of 'needing' to pump between feedings. We ran errands today and I went 3 hrs between pumping and I couldn't even physically 'tell'.

I'm using the PIS Advanced double pumping, but I'm wondering if I should try to go up to hospital grade. Wondering if that will make any difference.


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## MonkeysRUs (Jun 1, 2007)

From what I've read, there is a difference between the PIS and a hospital grade pump, so getting a hospital grade one might be worthwhile. I would also suggest asking your doctor to check your hemoglobin and iron levels and your thyroid levels.


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## Momsteader (Dec 13, 2002)

Thanks! I have an appointment on Thursday with my OB. He wanted to see me at 2 weeks out, because of the PPH. He'll run bloodwork, so I'll ask that he does the thyroid level as well. And, see if he write me a script for the pump. I'm not sure NEED one, but just in case, and that way maybe my insurance will cover it for a bit.

Thank you guys for all the support. I feel like I should know what the heck I'm doing since this is time number FOUR pumping for me! But, of course just when you get it all figured out....your body throws you for a loop! LOL


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## Electra375 (Oct 2, 2002)

Post pardum hemorrage puts you at risk of Sheehan Syndrome, so far I've heard it is thought of as "rare" by doctors, but in real life not so rare.
It comes from the lack of blood during the hemorrage to the Pitutiary gland, it can "show" as low thyroid symptoms, but not have low TSH levels.
So if the doc orders a TSH (thyroid stimulating hormone) test, ask for Free T3 and Free T4 levels. The Pitutitary hormone tests are determined by where you are in your cycle, I had those done, but he didn't tell me how they worked so I didn't know who to interpret the results since my cycle's bfing are not "normal".


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## mtnhighmama (Jan 15, 2005)

Hi Holly...

responded to your post over on SMO too...

The more reading I'm doing, the more I really think that it is important to have a comprehensive thyroid panel done, and have someone interpret it that actually knows what they are looking at. And, if you have previous levels to compare them too...

when were the twins born? Were they term? Did you have any issues with the pregnancy? Pre-e?

Is your supply still increasing daily?


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## Momsteader (Dec 13, 2002)

Born basically at term--38.5 weeks--7 lbs 10 oz and 6 lbs 9 oz. No issues whatsoever with the pregnancy except chronic low iron from 28w on. I've never had low iron in pregnancy before. No high BP (except for a few days transitory when I was feeling fluish and I don't think was related directly to the pregnancy as it went away). No Pre-E. Felt really well the entire time other than pregnancy induced carpal tunnel! OUCH.

It's going up a bit each day yes. Roughly 17 ounces yesterday. But, still, I have no 'let down' or full/empty feeling and the milk just trickles out the entire pumping. I pump for 30 mins and I'm still getting 'trickles' of milk at the end. I am getting some spraying initially for about 5 or 6 pulls of the pump, but that is it.

Taking Fenugreek 3 caps 3x a day, Blessed Thistle 3 caps 3x day, Marshmallow Root 2 caps 3x a day, RRL 2 caps 1x day, 26 mg iron supplement 4x per day, 18 mg iron 1x per day, 6 prenatals (Rainbow Light Complete and 6 is the dose!), Fish oil supplement, and then Dom 2 pills 4x per day for 80 mg total. Am I missing anything? LOL Also trying to keep up my 150g-170g of protein per day, but I haven't had much of an appetite, so I'm probably down around 100g a day is all. Mostly red meat and pork though--again trying to help w/ iron.

(I know I'm on a TON of iron--6 times the RDA I think last I looked--but that is what I was taking during my pregnancy and he said to continue until the 2 week check. I built up to that level over the last few months of pregnancy, because of my very low iron levels.)

So who would be more competent to intrepret a thyroid panel? What type of doc?


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## mtnhighmama (Jan 15, 2005)

Holy cow, woman! That's a lot of supplementing. you might be overloading. I know that this is not always the favorite idea, but when there is so much supplementing going on, the body can kind of get confused. You might want to go to JUST the vitamin supps for a few days, and pumping every 2 hours.

The trickling could be positioning too. Do you compress? I know that with the pump I have to help empty the breast to get them to stop trickling. Pumping is a pretty active task for me. If you aren't getting the breast really empty, the breast won't produce as much. Trying a different pump is a good idea. Adding heat right before and during hte pumping session willencourage a let down.

Each bf'ing relationship is different, so try not to compare pumping now with pumping for your previous surrobabe.

*Eat, eat eat*. Put bowls of snacks around the house. Try nuts, trail mixes, etc. Snack on flavored baked tofu, jerky, cheeses, yogurt, etc. Every time you sit down to pump, have a snack. And a glass of water. I don't think you need to be worrying about your iron so much. I imagine your levels will come back fine.

If you are not getting enough food (quality, not fluff), AND REST, your body will protect itself. Especially if the babes are not to breast.

Your ob should be able to read the test results, but sometimes they need to hear all the symptoms. Let him/her know about the milk supply issue, the weight loss, the lack of appetite, anything new or unusual happening with your body (any change in skin tone, nail beds, mucous membranes, hair loss, bleeding from cuts, nosebleeds, exhaustion, inability to sleep, depression or mood changes, etc.). Sometimes the symptoms of thyroid stuff are overlooked right after birth due to normal pp changes. They might not think to ask certain things or look into certain things if you don't tell them the complete story.

Also, make sure the doc knows ALL the supplementing you are doing and knows what they are for, etc.


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## Momsteader (Dec 13, 2002)

The LC I saw put me on all the supplements and suggested the Dom which I got from a local mama. I already pump every 2 hrs for 30 mins during the day--10 pumpings then after my midnight one I go to 3 am for 30 mins and then to 6 am and then start up every 2 hrs again/30 mins. I do compression once I'm about 10-15 mins in. Should I do it sooner?

I'm eating pretty well and drinking a lot. My hubby is ensuring that. He's doing all the cooking and plying me with snacks. I'll try to add more even when I'm not hungry. I sort of 'lost' all my feelings of hunger during the last few weeks of pregnancy and had been forcing myself to eat, and now I'm probably forgetting to eat as often as I should.

Oh yes, I know each time is different. And I'll try not to compare!

So when you say to drop all the supplements, you're saying maybe go to just my multi-vite? Dropping the Dom too? Seeing where I'm at for a baseline w/out all the supplements?


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## mtnhighmama (Jan 15, 2005)

It sounds like you are doing a really good job of taking care of yourself, and that you have care providers supporting you.

Are you seeing the LC regularly? Maybe ask her about the supplementing and taking a short break...she would probably be a better source and might have some ideas.

but really, it sounds like you are doing everything you can and taking good care of yourself...


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## Momsteader (Dec 13, 2002)

Quote:


Originally Posted by *mtnhighmama* 
but really, it sounds like you are doing everything you can and taking good care of yourself...

Other than maybe obsessing about milk production and stressing myself out!









I saw the LC once at the hospital and once last week. I'll talk to her on the phone this week after my OB appointment.


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## Momsteader (Dec 13, 2002)

Okay....update from me.....how CRAZY is this???

My IM's supply is coming in great, so I decided that I'll pump less and just go with whatever I'm getting and call it good. I need to sleep at night rather than waking up to pump. I'll be 2 weeks PP tomorrow.

SO, I cut out my middle of the night pumping and dropped to 6 pumpings total rather than 11 (8 am, 11 am, 2 pm, 5 pm, 8 pm, and 11 pm)..so I'm going to bed at 11pm and sleeping until 8 am and NOT pumping all night.....and I'm actually getting MORE milk this way!?!? I got 26 ounces the first day doing it (up from just 17 the day before) and then 33 ounces yesterday, and I'm on par to get 38 today!!? When I wake up in the morning, I'm pumping 12 ounces at once!!!!! Now THAT is more like it.

Isn't it crazy that pumping LESS is getting more milk?? I also dropped my time from 30 mins to 20-25 mins. We'll see if this will 'hold'. I'd be plenty happy with 40 ounces in 6 pumpings


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## narcheska (Jul 27, 2007)

That happened to me too! I was pumping 7am, 10am, then 10pm as I was running out of milk at 6pm every day and topped up baby with a bottle of EBM. Then baby suddenly refused the bottle and started screaming when she saw it, so I decided to give up expressing for a bit, and viola! more milk. It also continued, it wasn't a 2-3 day thing, I still have plenty of milk, and now have more milk in the evenings than I did when I was expressing. Maybe cause I stress less about it all?


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## Electra375 (Oct 2, 2002)

Supply and Demand will kick in and you will drop your supply b/c your demand has decreased, it does not happen over night, it takes a little time for the body to realize it isn't needed.
Now, on the other hand, if you are taking Domperidone or Reglan or other milk supply increasers, you may not drop your supply by much or it won't be as dramatic. I know I dropped pumping sessions after being on Domperidone and I still have enough, but baby started eat solids at the same time due to when I ordered and when it finally came in. I was barely, well not, making enough w/o Dom. now my 16 oz a day is enough.


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## Momsteader (Dec 13, 2002)

Thought I'd come and post an update for future reference in case anyone is going through this!

I am just over 3 weeks postpartum. I am just taking multi-vites and iron at this point. Dropped everything else. I had my check-up at 2w pp and my iron was mostly back up and I was feeling really, really well. I was down 38 lbs last week, and now I'm down 40, so I think that my weight loss has leveled off which is a good thing as I've already lost more than I gained (29 lbs).

I am now doing only 5 pumpings on most days-7 am, 11 am, 2 pm, 6 pm, and 10 pm for 20 minutes each time. Getting about 35 ounces and been doing that for about 10 days now! YAY! If I'm up late, or wake up feeling too full in the middle of the night, I get another pumping in and get another 3-4 ounces. But, it's reeeeallly nice to go all night and not pump. I get 12-15 ounces in the morning after sleeping all night....and that is almost half my days supply at once! LOL

I bump up to 4 hrs between in the afternoon/evening because we have things going on with activities and also I have less supply in the evening, so pumping more often wasn't making more milk, so why do it!! I'm going to do a 'marathon' few days of pumping some time after 6 weeks pp to see if I can jump start my supply above where it is or not. I was pumping 65 ounces regularly at this point in my last pregnancy, and I'd like to be there again if I can, but if I can't, I guess I can't and my body just doesn't want to do that this time!


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