Question: I am working with a mom, 2 weeks post partum who has placenta acreta. Her baby is in NICU. She has very little milk. The doctors are hoping that the placenta will reabsorb and we are wondering if she keeps pumping if there is a chance that she might begin producing milk later on. I am wondering if you have worked with a mother with this problem before. It’s my first time.
Jean Geurkink, IBCLC
Answer: Placenta accrete is a severe complication of pregnancy. It occurs when the placenta, which normally detaches easily from the uterine wall following the birth of a baby, implants abnormally through the endometrium and attaches to the middle layer of the uterine wall. In the most severe cases, the placenta grows all the way through the uterine wall and may even attach to other organs. Surgery is required to remove the placenta. There is risk of hemorrhage during removal, and sometimes hysterectomy is required. In severe cases, the condition can be fatal.
The cause of placenta accreta is unknown, but it can be related to placenta previa and there is an association with previous cesarean delivery. Multiple cesareans were present in over 60% of cases of placenta accreta. The risks to the baby include preterm delivery.
Complete delivery of the placenta is the trigger to initiate the onset of copious lactation. So long as placental fragments are retained hormones that suppress lactation may compromise full milk production. Secondly, excessive blood loss (and subsequent anemia) are both noted in the literature to cause diminished milk production (Willis 1995, Henly 1995).
Prematurity, itself, complicates lactation. Women who deliver early may not experience full glandular development of the breasts during pregnancy (Geddes 2007.) Experiencing a traumatic delivery and having an infant in the NICU contribute to maternal stress which also may undermine lactation performance. Finally, unless pumping is initiated in a timely manner, preterm babies are generally too weak to stimulate a full milk supply. Consequently, it is challenging to provide comprehensive lactation management for a mother in such a situation.
It is not surprising that this mother is struggling to make enough milk. It is critical to give the mother factual information about her situation so that she doesn’t blame herself. She needs to understand what has happened and to see it in the context of a rare and unlucky event. “Insurance pumping” assists in keeping receptors in the breast active and sustains the potential to lactate. As women recover their iron stores and recover from the blood loss, their milk supply may gradually increase over time.
I’ve worked before with clients who experienced excessive blood loss. Some have pumped heroically and got very little response. Over time (periods as long as 6-8 weeks), several recovered enough metabolic energy to produce normal milk volumes. However, each individual woman’s condition, energy and family support will influence her ability to be pump-dependent during convalescence.
Don’t forget that donor human milk from an accredited milk bank may be used to supplement the baby. Some mothers are greatly comforted to know their baby is still getting the unique benefits of human milk following so traumatic an experience. www.hmbana.org
Geddes D, Gross Anatomy of the Lactating Breast, in Hale and Hartman, Textbook of Human Lactation, Hale Publishing, Amarillo, 2007. p 23.
Henly S. Anderson C. Avery M, et al. Anemia and insufficient milk in first-time mothers. Birth 1995; 22(2):87-92.
Willis C, Livingstone V. Infant insufficient milk syndrome associated with maternal postpartum hemorrhage. J of Hum Lact 1995; 11(2):123-6.