I recently saw a mother with a 10-day-old baby.  She was using a nipple 
shield because of flat nipples.  She hated using it, said it kept falling 
off and the baby gagged on it, but baby was gaining weight.  Upon arrival, 
she desired to nurse on the left breast.  Her nipples were indeed very 
short, nearly flat and not very elastic.  We tried to latch baby (high 
palate) w/o the shield, but no sucking reflex.  She got out the shield, 
which was too big for her, and I showed her how to correctly put on the 
right size shield.  The baby nursed like a champ and took in 3.6 oz. in 
less than 10 min.  There was still milk in the left breast.  We tried to 
get him to take the other side (mom wanted practice) but we was out for 
the count.  Mom also said that he is extremely gassy and fusses a lot 
while passing gas.  I determined mom to have an overabundant supply and 
she wanted to know how to cut it back.  I suggested emptying first breast 
first, and pumping other breast for relief.  So mom would likely feed on 
one breast two times in a row, pump other side for relief only--not to 
empty--then repeat the process on the other side until milk supply calmed 
down a bit. Hopefully, this would help with the gassiness, too, I 
thought.  Well, mom calls me today (two days later) and says that she now 
has a breast infection and baby is refusing to nurse off the affected side 
(the side we didn't work on).  I gave her the typical responses for 
nursing through mastitis.  My question is, did I mismanage this case?  Was 
there a better way to handle the oversupply?  Was my advice related to her 
getting mastitis?  I'd really like some help here b/c this is what I 
usually tell moms with oversupply.  Any other suggestions?

Terri Lear, IBCLC
Breastfeeding Solutions, LLC
703-313-0040

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