Case Studies to Document Strategies Used by Mothers to Overcome Significant Maternal Morbidity Challenges to Successful Breastfeeding.

introductionThere is a scarcity of literature documenting how women facing maternal morbidity issues deal with challenges to breastfeeding. This case study documents challenges faced by two women, one who underwent major abdominal surgery immediately after a Caesarean section at 32 weeks, and the other who had a primary and secondary postpartum hemorrhage with repeated hospital admissions. MAIN ISSUE: In the first case, the key issues for lactation were the mother-infant separation and difficulty in initiation and sustaining breastfeeding due to abdominal surgery after her Caesarean section. Early and frequent removal of milk are critical for establishing and sustaining supply and were challenging for the mother in the intensive care unit for 3 weeks. The second case involved a mother experiencing severe postpartum hemorrhage. Having lost over 3 L of blood, this mother faced a significant risk of a reduction in prolactin and activation of her milk supply. Her subsequent weakness and dyspnoea due to anaemia meant breastfeeding required extraordinary effort. MANAGEMENT: Establishing lactation under these circumstances was challenging. Both mothers needed guidance and encouragement to build up and maintain their supply and the practical support of family to care for the infant. In Case Study 1, donor milk was used and alternated with artificial breastmilk substitutes until the mother re-established her supply after discharge. In Case Study 2, the mother required help to express, position, and hold the baby while she breastfed.

conclusionDespite overwhelming medical and physiological odds, it is possible to establish exclusive breastfeeding with consistent personalized health-system support/training and relentless determination.