Nahyra Lanzo-Espinosa
November 2021
Nahyra
Lanzo-Espinosa
,
BSN, RN, IBCLC
Lactation Specialist
NewYork Presbyterian Lower Manhattan Hospital
ny
,
NY
United States
Nahyra strongly recommended that the patient call her Provider immediately and request to be seen.
Our lactation consultant, Nahyra Lanzo-Espinoza, recently made a significant impact on the health and safety of one of our postpartum mothers. Her critical thinking and thorough assessment led to the recognition of abnormal postpartum bleeding and prevented a potential life-threatening outcome for this new mother. Nahyra first met this new mother after she had been discharged, but was at LMH visiting her newborn in the NICU. The NICU nurses had expressed concern that the new mother was not producing adequate breastmilk for being 7 days postpartum. Nahyra partnered with the patient to increase the frequency of pumping (power pumping) and made a plan to see her the following day.
When the mother’s milk supply still did not increase, Nahyra began to think of other possibilities for this decreased supply. She questioned the patient about her blood loss and the patient shared that she was still seeing clots on her pads. Nahyra immediately thought this could be due to retained placental parts, which would cause increased abnormal bleeding, thereby preventing prolactin to be released and milk from being produced. Nahyra strongly recommended that the patient call her Provider immediately and request to be seen. She also updated the OB team with her assessment and concerns, so that they were aware she would be calling. That evening, the patient presented to LMH and required a dilation and curettage (D&C) for retained placental parts. She was subsequently discharged home in stable condition. In the days to follow, the patient began producing milk.
In addition to positively impacting this mother’s outcome, Nahyra has shared this story with the team during recent huddles to help us all learn from this case. She has taught us how milk production can be a powerful tool in telling us when something isn’t right. In this case, the patient’s low milk supply was an indicator that the patient’s bleeding was abnormal. Nahyra’s astute assessment prevented this woman’s condition from worsening and from potentially becoming life-threatening.
When the mother’s milk supply still did not increase, Nahyra began to think of other possibilities for this decreased supply. She questioned the patient about her blood loss and the patient shared that she was still seeing clots on her pads. Nahyra immediately thought this could be due to retained placental parts, which would cause increased abnormal bleeding, thereby preventing prolactin to be released and milk from being produced. Nahyra strongly recommended that the patient call her Provider immediately and request to be seen. She also updated the OB team with her assessment and concerns, so that they were aware she would be calling. That evening, the patient presented to LMH and required a dilation and curettage (D&C) for retained placental parts. She was subsequently discharged home in stable condition. In the days to follow, the patient began producing milk.
In addition to positively impacting this mother’s outcome, Nahyra has shared this story with the team during recent huddles to help us all learn from this case. She has taught us how milk production can be a powerful tool in telling us when something isn’t right. In this case, the patient’s low milk supply was an indicator that the patient’s bleeding was abnormal. Nahyra’s astute assessment prevented this woman’s condition from worsening and from potentially becoming life-threatening.