Hi:

I am posting this for a fellow IBCLC who is trying her best to help this mom.  She does have permission to share:

Mom had a spontaneous vaginal delivery with epidural.  First feeding that IBCLC assisted with, baby appeared to be sucking nutritively, but she kept having to take  baby off because of pain.  Put on supplementer with G5W and baby nursed for 20 minutes, but entire feeding was very painful. . 

Mom has breast implants which were put in before she attempted to nurse her 5 year old.  Mom tried for 2 weeks to breastfeed her last baby (the 5 year old).  She said her nipples were cracked and bleeding when she left the hospital with the baby less than 24 hours of age.  she pumped, but did not feed the baby the pink milk.  At 2 weeks, when her nipples healed, the baby refused the breast.

 LC did not lift her breasts, but suspect they are either under the breast or in the axilla.  Mom is now requesting no bottles, no pacifiers and no formula.  She expects that with good latch and positioning everything will be OK when her milk comes in.  She says she could pump a full bottle with her last baby.  She has a Nurture 3 pump, but is now pumping with Hospital Grade pump.  Myself and another IBCLC have been working with this mom.  We have been able to express colostrum, but she didn't get anything she she pumped.  Every time baby breastfeeds the nipples are wedge-shaped after the feeding with a row of tiny blisters on the tip.  Feedings are painful.  Baby will suck a few times with wide rhythmic jaw excursions and falls asleep.

Mom is having severe afterbirth pains, which is only partially relieved by Percoset and Motrin .  Breastfeeding worsens the cramping significantly.  Pumping did not increase the cramping.  Mom single pumped by choice ( modesty issues?) and was comfortable on minimum suction with pump

We have tried all of the following to decrease the breast and nipple pain and nothing has helped:

breast compression
tilting nipple up,
tilting nipple down, 
pulling down on the chin
supporting the chin
TMJ massage
giving 5% glucose water through Starter SNS.

The positioning and latch have been LC assisted and appear perfect. Parents do not want to give formula at this time, so plan for next feeding is to use glucose water by supplementer at breast and assist the flow.  If that doesn't work, mom wants to supplement with cup or spoon.

We are stumped and mom really wants to breastfeed.  Any insight you can share would be much appreciated.

Lori J. Isenstadt, IBCLC
Peoria, AZ


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