I do not have any special expertise except anecdotal for several mothers
over the years. But here are my thoughts.
<but has extreme pain
>>when feeding (the midwife who called me couldn't tell me if the pain
>>continued between feeds)>
<Apparently this
>>woman has asked the midwife to "give the baby a bottle" for the next
feed
>as
>>it is just too painful, so I need information ASAP. Sorry I can't give
>more
>>information at this stage as everything I've been told has been 2nd
hand.>
One thing I would consider important is more precision in describing
whether the pain being experienced is in the nipple-areolar complex
and/or in the breast itself? It would be important not only to examine
the breast first hand but to observe a feeding, to provide objectivity.
Anxiety may be making the mother unable to be very objective about the
source of the pain, as she is the person who underwent the surgery and
has had months to worry about it. She may have been anticipating it would
hurt more than her first experience, setting up the possibility of a
self-fulfilling prophecy in her mind.
Is this baby bigger and a more vigorous nurser than the first? Let's be
sure all the usual latch factors (tongue tie/action, eccentric grasp,
babe tucked in firmly etc.) have been checked out thoroughly first rather
than automatically assuming that the surgery is the culprit.
Where is the incisional scar in relation to the edge of the areola and
the breast tissue, and compared with the location of the pain?
How long before the pregnancy was the surgery done? It sounds as if that
amount of time + 9 months would have allowed internal and external
incisions to be well healed.
However, even relatively new scar tissue may be somewhat painful when
stretched severely. She is, after all, 4 days postpartum. Let's hope that
factors like multiple IV's, IV pitocin induction, and/or epidurals that
are so common in the US are not causing extra severe and prolonged
engorgement.
And as you mentioned, at what point in the feeding is the pain
experienced? And for how long? Observation of a feed should help
correlate whether pain is coinciding with MER. Can using a pain scale
help to identify if the level of pain reduces considerably within a few
minutes after latching as it often does if the milk sinuses were
overdistended to begin with? If so, gentle digital extraction to soften
the areola before latching often reduces latch pain, in addition to
reducing tissue resistance to the baby's efforts.
As for the breast itself and any interrupted ducts/painful MER, ice packs
for 20 minutes 3-4 times a day to reduce the circulation to the alveoli
whose ducts were blocked worked just fine for the 2 mothers I am
remembering, many years ago, before cabbage compresses became common
knowledge.
I do not think her situation re: engorgement would be any more painful
that severe engorgement in a mother without a breast reduction. I think
nature will take care of involution of blocked alveolar tissue in short
order by the same means that allows some mothers to wean "cold turkey".
(That phrase has nothing to do with my preoccupation with readying our
Thanksgiving feast-it's simply our slang for sudden cessation of any
activity.)
I hope these thoughts provide "Food for Thought" because "Breastfeeding
Matters"! (Hi, Maureen)
K. Jean Cotterman RNC, IBCLC
Dayton, OH USA
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