Dear wiseones,

I am having a triple whammy of severely inverted nipples, engorgement and a posterior tongue tie. Permission to post. 

Primipara 29 years old has severely inverted nipples. Nipples are dimpled deep into her breast at rest and gets more inverted during a protactility test. her nipples appear to be adhered to the tissue behind. Mother has a c-section and baby not given to her until the 3rd day in the pretext of giving rest to both baby and mother. Baby was on 30 ml per feed formula from day one! She managed to begin using a small tiny hand pump to bring her nipple out and up until she saw me yesterday at 4 weeks, the only thing that has helped bring her nipple out temporarily is the same hand horn like pump.What she use is here (http://www.shopbug.com/catalog/popup_image.php/pID/5441?osCsid=5fbvlp0job1glh2kkhb74gf2p3). Baby had been nursing well for sometime until sudden she developed engorgement on both her breasts and more severe on one breast. Baby is unable to drain breast well since baby has posterior tongue tie and a thick maxillary labial tie identified
 during my assessment. I tried massage and RPS for over 30 mins and finally saw trickles of milk flowing out of the breasts. I then tried to use a single electric pump (Medela Swing) which mother had to see if this can drain her breast. Her soft palpable right breast post massage suddenly hardened and grew very painful for her. Not a drop of milk during pumping and I noticed that the pumping was not helping evert her nipple and was only possible with a small flange nipple puller (not sure of the size of this flange). The smallest size flange available is 21 mm and I think she may need smaller than that inorder to be able to manage to evert her nipples and manage to express. 

Hand expression is helping very little. I also notice that her nipple pores could be located only under the adhered portion of her nipples and not the exposed portion. While the parents decide on the release of Posterior tongue tie for baby, mother needs relief from engorgement. Cold therapy is helping reduce her pain. With massage, RPS and nipple shield baby is managing to nurse ok on the left breast.

Please share your suggestions and possibilities on what else are my options.

Thank you for all your help already for listening.

Yasmin
MA,HDSE,CLEC(USA),LLLL,IBCLC
Nourish & Nurture Lactation & Parenting Services 

[log in to unmask]
www.nourishandnurture.in
Mumbai, India

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