Hi all!

The mom who gave me permission to post her case has delivered. Baby girl came on her due date (yesterday). I was off yesterday, so just met her today. I found a very cute little girl with a small, tight mouth and a posterior tongue tie. Mom was already struggling to latch her. I also had a chance to do a more detailed exam on mom. Findings: very large (appx H cup), very soft and pillowy breasts. Large areolas (>3"diameter)  and small, almost eroded looking nipples (about the size of an m&m candy). She says they were always like that. Mom's areola skin and overall breast skin are extremely elastic. I've been struggling for ways to describe this. No matter what we tried, the nipple and areola sunk away from the baby when she tried to latch. We tried a nipple shield to draw out her nipple and protect her skin from the effects of the baby's twisty latch. The nipple slightly everted into the shield, but when baby tried to acquire the shielded nipple the entire area sank away from baby. Mom reports extreme sensitivity with her nipples, just the slight vacuum of drawing the nipple into the shield caused her to wince. Mom had a very stressful time of it with her previous infant and doesn't even want to consider pumping. I encouraged breast massage and tried to show her hand expression. Mom felt able to massage breasts but did not do well with hand expression or RPS technique. There were many more tears than milk today. I left them doing skin-to-skin care and having mom massage breasts regularly. I also left her literature on dividing frenulae (plural of frenulum?) as she was unsure about subjecting baby to a procedure. I am going to give them the MOBI site, TLC, and not sure what else... any ideas or critiques of what I am missing would be greatly appreciated (again) 
Kindly,
Leslie Cree, IBCLC
Harrisburg/Lebanon, PA USA

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