Over my now almost 40 year career I think I recommend less and less
products and things on the nipples. For this particular client there could
be some underlying emotional, anxiety, fear contributing to the pain
feelings. Of course I don't discount the oamer. I do find mothers with the
overactive letdown like and find it helps to use the straddle hold. I would
have her discontinue the products, however I do like just a little normal
saline rinse, pat dry with very soft cotton cloth and expose the nipples to
Air and light as much as possible. Mother can drink some mint tea
throughout the day, that will be a mild anti-galactagogue. A short period
at start of feed of hand expressing or catching the first sprays of milk
with a hand pump or a cloth. Achieve the deepest latch and immediately
de-latch the baby when the strong let down occurs or baby gives signs of
distress. Catch those sprays in a cloth and calm and burp the baby well
then reattach. I may be one of the few that puts less emphasis on tongue
ties and lip ties and multiple revisions and such. I think the mother could
be put on ibuprofen for example and probiotics for several days. I know
recent study showed the probiotics are not helpful but I don't think they
are harmful. This could be a mother who could potentially need to be
treated with a medication like Lyrica for example however I am definitely
not an expert on that. If this mother needs a couple of days of just
expressing to sort of regulate her Supply and allow her breasts to calm
down that could be something that will allow her to cope and continue while
the baby is fed by paced bottle feeding. These cases are quite difficult
and of course this mother will need a lot of support. I like for the mother
to do most of the talking as we often feel we have to suggest this or that
but often she will lead you to what she feels or knows is going on or where
she wants to go from here. Laurie wheeler RN MN ibclc Mississippi USA

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