Friends, I have an unusual situation before me and mother's permission to post.
22 year old, first baby, 37 weeks gestation, vaginal delivery. Mother states her bra size was 34B before pregnancy, but grew to 34 LL by the end of pregnancy. She said the outer area of her breasts were thickening by the time of delivery. Today, 18 hours postpartum, her breasts were so thick and full, we could not "pit" the areolae using Reverse Pressure Softening.
I cannot tell how much mammary tissue growth she had in pregnancy. It is difficult to palpate anything. She says the breasts are not painful, but the weight is cumbersome. Her skin is so tight, the pores are easily visible.
Mom is taking ibuprofen for pain, but nothing stronger. Baby is acting even younger than 37 weeks and makes very little sucking effort and no rooting behavior at all. Dear mother wanted so much to breastfeed.
I set up a pump, had her massage her breasts, then do reverse pressure softening, then started the pump. I used largest flanges as the areola diameter is about 4 inches. I suspect the nipple itself would fit into a 16mm nipple shield, however. We were only able to pump drops of colostrum.
Doctor's orders were to either bottle or gavage feed (based on poor feeding behavior), so I helped her bottle feed and must say the baby was a most reluctant feeding. She only took 15ml ABM/colostrum and then began to gag.
After reading the Lactnet archives, I called mother's night nurse and encouraged her to give the mother ice packs to use ad lib throughout the night. Also continue RPS before pumping. Mother wanted to know if she could attempt to breastfeed and I encouraged the nurse to help her.
I hadn't thought of using bromocriptine because mother's supply seems blocked by the tremendous swelling. Also, I feel the ibuprofen may be a good anti-inflammatory in this situation. The OB thought of trying Lasix, but was reluctant since the swelling is specific to the breast, none in ankles, feet, hands, etc.
Any suggestions? Encouragements?
Thanks
Jeanne Mitchell, RN IBCLC
Austin, TX
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