Hi Folks,
Any input or comments about the following case would be welcome.
Asked to see a mom this weekend, 19yo, G1 P1, baby son born 7/18/02 weighing
6 pounds 14 ounces.  Vag birth, no IVF other than a brief hit of pitocin and
one of stadol.

Home visit Sunday 7/21, baby's weight 6 pounds 4.5 ounces, so approx. 8-10%
weight loss.  Mom has smallish breasts with very prominent, "bulbous"
areolas - they look just like the photo in 'Clinical Lactation, A Visual
Guide' by Auerbach and Riordan, on page 61.  Breasts are not widely spaced.
Mom reported "milk in" on morning of 7/21, and able to hand express copious
amounts milk, as well as dripping while baby feeding off opposite breast.
Baby latches to breast well, but is sleepy due to hyper-bili. Bili was 12.2,
went to 15.7, and today is 19.5, so he is being re-admitted for
phototherapy.
I taught mom how to hand express since her breast shape does not "fit" well
into the Avent pump flange.  The plan when I left them yesterday was to feed
baby at least 10-14 times per 24 hours, place babe in indirect sunlight,
hand express after each feed and cup feed baby.  I am sure today he will get
formula supps when readmitted, since that is the way our facility works,
although they will first give him whatever she can hand express.  Also, when
I saw them yesterday early afternoon, baby had not stooled since the evening
before.
I wonder about her capacity to make *sufficient* milk, but I believe it will
be a wait and see approach.   I wanted to share because this is the first
time I have seen this shape of breast, and also to ask those of you with
more experience if there is anything you would add or suggest additionally.
Thanks!
Ann Marie Henninger

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