Re Niefert's primary vs secondary IMS:
I was just doing some calculations. Now all of this is from memory, I
don't have the consults in front of me. I have been working for last 15
mos in hosp program. We have 60% bf initiation rate. Now we have about
720 births per year or 900 in last 15 mos; 60% bf rate is 540 bf'ers in
15 mos. I believe we have seen 4 IMS pts. That is 4 out of 540 which is
0.74% (feel free to check my math :)). The histories were:
1. wide spaced tubular breasts - no breast changes, no engorgement -
primary
2. another pt with normal looking breasts but no lactogenesis and we
find out (she tells us) she is sister of the above woman - I did not see
this one personally - primary?
3. Slow gaining baby came to us about 11 wks; hx of PP hemorrhage in
mom, shock, blood transfusions, then put on birth control pill early -
Sheehan's?
4. C section birth, very obese pt, UTI on abx w/ catheter still
currently @ 8 days, still no breast changes. Had C/S due to ? uterus and
bladder in wrong position ? Also, tight frenulum having some impact I
think - mixed etiology?
I am not counting the lady with br. reduction surg, that would be 5 out
of 540 or 0.92%.
All of these were brought in very early (except #3 who came to us from
another hosp), followed with optimal bf management, supplementation  at
breast (sns) is offered and #3 and #4 did use this, regular milk
expression with hosp grade double pump, herbs, and often metoclopramide
(mom's choice and if ok with her m.d.).

Laurie Wheeler, RN, MN, IBCLC
SE USA
mailto:[log in to unmask]


______________________________________________________
Get Your Private, Free Email at http://www.hotmail.com