Hi!  I have been lurking for a long time-this is my
first general post.  Have been IBCLC over 10 years,
currently work both in a large hospital as an LC and
a private pediatric practice an an LC.

Case study:  28 y.o. WF presented in my office with a
6 day old male infant.  BW had been 9lb 3oz, was 8 lb
1oz in office.  Parents had been supplementing about
4 times a day because infant was "not happy at the
breast".  Had been nursing since delivery, at least
every 2-3 hours.  Nipples mildly abraded bilaterally.
 Positive breast changes during pregnancy.  No
medical or surgical history in mother.  Breast
appeared normal, very flaccid though.  Could manually
express transitional milk.  Observed infant latch-did
well, but easily frustrated.  Sent parents home
feeding baby with bottle, mom to start DP every 3
hours, put baby to breast for comfort.

On return visit, 5 days later, infant had surpassed
birth weight.  Mom had pumped every 2 hours times 3
days-no change whatsoever in breast.  Never pumped
out a drop of milk, infant would not even take breast
for comfort.  Mom's bleeding had decreased normally,
but cramps and period started at day 10.  Mom also
having low-grade temp.  Suggested she call OB and
report symptoms.  At this point they have given up on
breastfeeding.  I promised I would ask for
suggestions on why her milk never came in.  She was
never engorged-my only possible thought is small
placental retention.  Please advise.   Thank you.




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