>From: Ann Marie <[log in to unmask]>
>Reply-To: Lactation Information and Discussion
><[log in to unmask]>
>To: [log in to unmask]
>Subject: bulbous areolas (?)
>Date: Mon, 22 Jul 2002 16:36:56 -0700
>
>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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I have seen this occur many, many times, unfortunately with usually poor
outcomes
for exclusive nursing. These moms will report milk as "being in" and yet
the ac/pc
weights I've done have given small volumes of milk usually less than an
ounce. I would
quickly try galactagogues of choice, breast compression and an SNS if
receptive.
IMHO these babies act like mom is giving fairly large amounts of skim milk
as you will likely
observe early swallowing in these babies at breast in the first few days
too, more so than
the average. I'd have to guess a lack of fat content and calories as
evidenced by lack of
stooling and frantic behavior often right after a feeding in addition to
quantity. In my early
LC days, I'd recommend additional hospital grade pumping to enhance
production, but
haven't found that to be tremendously helpful if the baby is already doing a
good job.
These variations in breast anatomy, makes for one of the more difficlut
aspects of our jobs,
when we are sought out to "fix' the problem. This is one of those times it
may not happen .
Just my .02.
LuAnn Smith
York, PA
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