Hi All,

 

I am working with a first-time mommy – age 41 – got pregnant first time she
tried – with twins – no history of fertility or hormonal issues of any kind
– family history of low thyroid but has had that regularly checked every 6
months or so – even during pregnancy.  Babies born by C-Sec on 8-31-06 at 38
wks – weighing in at (get this!) 7’11” and 7’9”!  No history of gest
diabetes…

 

She had major breast changes during pregnancy – she was an F or G cup to
begin with now is well over J.  Very large nipples.  Developed fairly nasty
case of mastitis within 12 hours of the c-sec in right breast.  Red
inflamed, very swollen.  Doc put her on antibiotics but mom had a bad
reaction to those so Doc took her off after 48 hours and did not replace
with anything else.  Mom reports she felt like milk was coming in around day
3-4  but only getting dribbles and drops.  Used a Classic in the hospital
but it HURT (flanges were too small – I upped her to 36mm flanges when I saw
them on day 5).  Babies cannot latch on to these very large nipples yet and
– here is the issue – there is no milk yet – still just dribbles and drops.
Mom has done breast massage and tried some hand expression with me there but
unable to get more than a drop or two.

 

Mom is using a Symphony breastpump (the only thing she could get – and she
was resistant to using a Classic again due to first experience of pain with
pumping due to too small shields).  She is having a hard time getting in the
needed pumpings – more like every 4 hours vs. every 3.  She is exhausted – I
saw the mastitis coming back with a vengeance and put her on full bed-rest
with instructions to call the Doc again and discuss other antibiotic
options.  She refused to talk to Dr about more meds and stayed on bedrest –
sleeping and pumping when she could.  After 2 days she was much better –
breast is normal looking now and much more comfortable.  They were using
cabbage to help with edema in both breasts but did not stop after the
swelling was gone as instructed by me and by the handout I gave them – they
continued to use it for another 2 days!  I have never seen cabbage actually
reduce a milk supply tho I know some think it can.  While pumping mom forgot
to do the breast massage I instructed her to do…there is a lot of
non-compliance here mainly due to exhaustion.  

 

Talked to them Friday – day 8.  Still no milk – just drops – ½ ounce at most
total from both breasts put together.  I have recommended prolactin levels
and thyroid levels get tested NOW to rule out hormonal issues with milk
production.   Mom even strongly resisted the testing due to hating getting
blood work done – but hubby managed to convince her to ‘give it a thought
and try…”.  

 

Now what?  I don’t think I have ever worked with someone whose breasts were
this large!  Is it possible that with the Classic and too-small flanges,
along with Mastitis and not frequent enough pumping that her milk supply is
permanently compromised?  Is it possible that the milk is there somewhere in
all that breast tissue and the pump just can’t get it?  I know that
C-sections can delay the milk supply coming in but this long?  

 

It has been a LONG and BUSY week and my brain is absolute MUSH right now.  I
am open to all ideas and suggestions…  One thing I know for sure I can’t
make it happen for someone who says she wants to produce milk – wants to BF
– but is not able to do what is needed to have a better chance of getting
there…

 

Help?

 

TIA…

 

Sleepy Jaye…

 

 

 


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