I am stumped and I have gotten permission to ask for help.
I am working with a mom who gave birth to a 7#7oz boy. When I first saw them
the baby was 2.5 weeks old, weighed 8#14 oz and has been supplemented with
formula pretty regularly. She has not been putting baby to breast at all
because of pain. Baby's pees have been good, stool mixed because of formula
supplementation, but did mention a bit of green in the yellow breastfed
stool.
Mom experienced slight breast enlargement during pregnancy, more marked
enlargement gradually after the first couple of days, but isn't sure she
experienced engorgement, or actually thought she was still engorged, since
there hasn't been much variation in breast size & firmness since her milk
came in.
Mom reported nipple soreness even at the baby's first feed, but increased
over the first few days as she continued to try to nurse. She reports
excruciating nipple pain at latch on and sharp pains in her breast during
feeds as well as in between feeds. She has been pumping every 3 hours and
averaging 65ml of milk per pumping. Pumping is also painful, but tolerable.
She has keep detailed records of feeds, pumping sessions and milk produced.
After listening to her description of the pain, I expected to see swollen,
engorged breasts with abraded nipples, perhaps with oversupply issues. On
the contrary, her smallish breasts looked very normal. No swelling, no
puffiness, firm but not hard, not hot, no redness or lumpiness. Nipples were
well shaped and without cracks or abrasion.
She did not put the baby to breast, saying her breasts were too tender. We
pumped with her P__in__Style and the movement of her nipples in the flange
seemed normal. Tried different sized flanges w/o observable difference. I
asked her to describe her pain threshold overall. She looked at her husband
and they both sort of chuckled as she said it was low. Clearly they had
discussed this possibility.
The pain seems to be closely related to milk filling and emptying. She gets
some relief after pumping, but within 1/2-1 hour, the tenderness and pain
have returned and gradually increase until she pumps again.
I suggested trying to put the baby to breast after giving him a partial feed
from the bottle to try to get beyond the latch on pain when he wasn't
suckling as vigorously. Or to pump until she began to feel some relief from
the pain and then put him to the breast.
I encouraged her to try feeding him more often if he would cooperate,
getting him to nurse when the pain might be less. I suggested she keep
pumping thoroughly, watching not the clock but milk flow. And, since I
thought she would try to get him back to the breast, to let him really
finish the first side first. I suggested they give him pumped milk in the
bottle before giving formula and then if he was unsatisfied, to put him to
breast.
I talked with her yesterday and she reported no improvement. She now
describes the breast pain as "pins & needles" starting 20 minutes after a
thorough pumping and lasting until the next pumping. She is pumping every 3
hours, producing 3 oz of milk. Baby is taking 4 oz every 4 hours. I'm not
sure she tried much at the breast, saying it was still too painful. If they
give just the 3 oz pumped milk, the baby is satisfied for about 20 min &
then screams. Will not take a pacifier. Once they give the additional ounce
of formula, he sleeps contentedly.
I'm beginning to think this is about the mom's sense of order and perhaps
some other issues with her body. But is there something else I am missing?
And if it truly might be the mom's issues, how in the world do you discuss
that?
--
Sue Petracek, IBCLC * Bosom Buddies, Inc.
Denver, Colorado, USA * www.bosombuddies.com
720-482-0109 * 888-860-0041
The place to find everything a breastfeeding mom could need.
--
Sue Petracek, IBCLC * Bosom Buddies, Inc.
Denver, Colorado, USA * www.bosombuddies.com
720-482-0109 * 888-860-0041
The place to find everything a breastfeeding mom could need.
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