Breastfeeding With a Retained Placenta

Woman getting an abdominal ultrasound. Breastfeeding and a Retained Placenta: Signs, Diagnosis, Treatment
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The placenta is a temporary organ that attaches to the inside of your uterus during pregnancy grows in the wall of your uterus during pregnancy. Through the umbilical cord, the placenta connects you and your baby while your child is growing in your womb. After the birth of your baby, the placenta detaches from your uterus and exits your body. This typically occurs within 30 minutes of vaginal or cesarean delivery. If part or all of your placenta is not naturally expelled from your body, you will be diagnosed as having a retained placenta.

Signs and Symptoms

The most obvious sign of a retained placenta is your placenta not delivering within one hour after you give birth. In most cases, your doctor will notice if a piece of your placenta is missing. However, if this goes unnoticed, you may experience the following symptoms in the days and weeks after childbirth:

  • Fever
  • Foul-smelling vaginal discharge
  • Delayed onset of lactation
  • Persistent, heavy bleeding with blood clots
  • Severe pelvic pain

Effects on Production of Breast Milk

While you're pregnant, the placenta produces the hormones estrogen and progesterone. These hormones prevent your body from making breast milk before you have your baby. During childbirth, you deliver your baby; then, the placenta also leaves your body. Once the placenta is out of your body, the levels of estrogen and progesterone drop. The drop in estrogen and progesterone trigger a rise in prolactin, the hormone responsible for producing breast milk.

If any part of the placenta remains in your body after the delivery of your baby, your prolactin levels will not rise, and your body will not begin to make breast milk.

Breastfeeding

Breastfeeding with a retained placenta is difficult. Since you can't make a healthy supply of breast milk while the placenta remains in your body, your baby will be frustrated and show signs of hunger even after you breastfeed her. And, the longer your milk production is delayed, the more dangerous it is for your child. Your baby may begin to lose too much weight, develop jaundice, and become dehydrated.

When to Get Help

If your breasts do not fill up with breast milk by the third or fourth day after your baby is born, notify your doctor immediately for a checkup. You should also bring your baby to see his doctor for an examination. Your baby's health care provider will weigh your baby and talk to you about whether or not your baby is getting enough breast milk. While you're trying to fix this issue, you may have to supplement your baby's diet.

Diagnosis

If your doctor suspects that you have a retained placenta, she will probably perform a physical examination, check your blood for levels of human chorionic gonadotropin (HCG), and do an ultrasound to look for pieces of the placenta left behind in your uterus.

Treatment

If, after your doctor examines you and reviews the results of your tests, she determines that you do have a retained placenta, it's necessary to take action. Your doctor will perform a surgery called a dilation and curettage (D&C) to remove any bits of the placenta that are still inside your body. Once you've been treated and the remaining pieces of the retained placenta are removed, full milk production can begin, and you should see an increase in your breast milk supply.

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Article Sources

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  1. World Health Organization. WHO recommendation on cord traction and oxytocin for retained placenta. Published September 21, 2012.


  2. Adkins K, Minardi J, Setzer E, Williams D. Retained Products of Conception: An Atypical Presentation Diagnosed Immediately with Bedside Emergency Ultrasound. Case Rep Emerg Med. 2016;2016:9124967. doi:10.1155/2016/9124967


  3. Berens PD, Villanueva M, Nader S, Swaim LS. Isolated prolactin deficiency: A possible culprit in lactation failure. AACE Clinical Case Reports. 2018;4(6):e509-e512. doi:10.4158/ACCR-2018-0132


  4. World Health Organization. Management of breast conditions and other breastfeeding difficulties. In: Infant and young child feeding: model chapter for textbooks for medical students and allied health professionals. Geneva: WHO Press; 2009.


Additional Reading

  • Lawrence, Ruth A., MD, Lawrence, Robert M., MD. (2011). Breastfeeding A Guide For The Medical Profession Seventh Edition.  Mosby.
  • Newman, Jack, MD, Pitman, Theresa. The Ultimate Breastfeeding Book of Answers. Three Rivers Press. New York. 2006.
  • Riordan, J., Wambach, K. Breastfeeding and Human Lactation Fourth Edition. Jones and Bartlett Learning. 2010.