Hello Fellow Lactnetters.

Where is Peter Hartmann when you need him? Seriously - I have permission to 
post. I am leaving for vacation in 2 days and am working with a mom I'd like 
to assist prior to my leaving....

This gr 2 mom with hx of poorly functioning left breast last time, leading 
to early weaning.  At taht time we thoough it was an ineffective pump. This 
delivery the breasts appear similar in size bilaterally, but with a fairly 
rigid nipple base and now extreme firmness.. Left nipple is much larger than 
right and is Mom is now using a 30mm flange and a Symphony to assist with 
breast emptying.

This baby born last Saturday had complications r/t ABO issues and was mildly 
asphyxiated at birth, both of which complicated early feeds at breast. Baby 
remains sluggsih at breast and refuses the left breast entirley, but nurses 
very well on the right.

Mother has NEVER pumped more than 5 mls from this  left breast despite 
extreme firmness, unrelieved by RPS, ice, heat, cabbage and gentle massage. 
She had one episode of pumping thick stringy milk, but now just normal 
appearing colostrum. She is in fairly severe pain and I hesitatie to 
continue pumping without milk removal. No evidence of mastits. She denies 
sports injury, compression injury, surgery, etc. Nipple looks slightly 
crusty, consistent with dried colostrum.

I spoke with OB - who ordered an ultrasound to r/o stenosis or obstruction 
or tumor and all was negative. The radiologist was at a loss to explain this 
to mom. I'm wondering how conclusive this testing would be for outright 
obstruction of the nipple pores.

At this point, I am steering the mother gently towards unilateral feeding, 
but I sure would like to give her some answers.

At a loss, and of course this is someone I know personallyy and would like 
things to go very well for her....

LuAnn Smith RN, BSN,IBCLC
York, PA

On a cold winter's night! of 12 degrees and heading lower!

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