Hi everyone!
Been away from Lactnet for a while and find that I´m missing all its
richness. The fast-pacedness of the Facebook groups has its virtues, but I
find little space for personal reflection on each post, since they are so
many and so fast....
Thanks to everyone who keeps this particular space alive!
So, to celebrate that "I´m back home" :) I´d like to share a case...
My client had breast augmentation surgery 15 years ago. She had no problem
breastfeeding her older child 8 years ago. Last year, in february (just
before first major pandemic lockdown) she had a new breast surgery, to
replace the implants as the old ones had begun to leak. A couple of months
later she became pregnant.
Her current consultation is with her second child, a 3 week-old infant.
Mother reports intense pain in left nipple upon latching and during feed.
Also, for the past few days, baby has been irritable and stools have turned
green (not all, but a few each day).
Birth was normal, with immediate skin to skin contact; milk came in on the
evening of the second day. Mother reports feeling her let-down reflex as a
tingling sensation. Baby has had good weight gain, regaining birth weigh on
day 10, albeit a bit slower gain this last week (21 gr per day).
Upon examination, infant is looking good (no asymmetries, no ties, normal
development for age), mother has periareolar scars from surgery. The scar
on the left nipple goes completely around it (mother explains that niplee
position was corrected during latest surgery) and periareolar scar on left
breast goes from 3 o'clock to 9 o´clock.
Feed: mother is proficient at helping her baby latch with a good cradle
position, baby latches onto left breast and starts stimulating with a fast
suckle - which gets faster and stronger and painful and milk ejection
reflex is not forthcoming. Baby is very insistent and does not give up and
mother remarks that this is what has been happening, this very vigorous
suckling but no MER that she can feel.
I ask mother to begin hand expression simultaneously on the other breast
(she is a fast learner!) thinking to activate her MER this way, but even
though she expresses milk from the right breast while baby suckles on left,
there is no MER. So I suggest she switch baby to right breast to see if
that will elicit MER - and it does. When left breast starts to leak
profusely, we switch baby back to left breast, where she maintains a deep,
effective suckle with great milk transfer - and no pain.
Mother does this several times during the feed - we´re trying to make sure
baby gets all that rich milk that MERs provide, thinking that this lack of
MER activation on the left breast may be responsible for her green stools,
irritability and slight fall in weight gain.
I thought this was a very interesting case, had never had a similar one.
I´m kind of surprised that the areola that suffered less surgical trauma is
the one that is neurologically affected, but it is clearly the case. I
guess the right breast nerves have regenerated faster. Outwardly, the scar
tissue was minimal on both breasts, no atypical or excess scarring at all.
Would love to read your input!!
Have a wonderful weekend,
Kika
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