POSTPARTUM OBSTETRIC FACTORS
Postpartum haemorrhage (PPH) may cause separation from baby in the early period, and increased fatigue. Breastfeeding challenges are reported and the likelihood of exclusive breastfeeding in the first postpartum week is reduced with higher levels of blood loss, caesarean section and longer delay to first breastfeed. However this study still showed exclusive breastfeeding rates at 2 and 4 months that are similar to the surrounding population. Breastfeeding/chestfeeding support should be intensified in a similar way to that outlined for caesarean section to minimise the effect of PPH on breastfeeding/chestfeeding establishment.
Very rarely, difficulty in establishing lactation after a PPH may be the result of acute pituitary failure (Sheehan’s syndrome). There is little information about how lactation is affected after this has been diagnosed and treated.
This is a useful article on postpartum thyroiditis, which recommends that TSH should be checked with all parents experiencing unexplained lactation difficulties in the 12 weeks after birth.