I had 3 referrals to see a mom was having trouble getting baby latched. As
soon as she pulled down her gown I saw the situation: precisely defined
areolar edge and a scar that ran down from 6:00 on the areola & disappeared
under the breast. She had had reduction surgery >12 yrs ago in another
country. Nothing in her H&P. Nothing in the Notes from her time of
admission. 
Yes, mom did feel her breasts becoming more dense and heavier. Nipples were
inelastic & firm, but her breast could be sandwiched slightly. I helped her
get baby latched. 

The initial suckling was extremely painful to her. She assigned an 8 on the
0 to 10 scale. It eased off to 4-5 after a couple of minutes. Baby had good
rhythmic suckling & swallows were audible approx 5 suckles initially,
increasing to approx 2 suckles - that little "kahh-kahh" of air from his
nose.

Gave her standard instructions to monitor for proof of adequate intake and
output & informed her of the possibility of supps/comps if baby doesn't
gain weight well or make enough of the right kind of diapers. Baby was
making appropriate diapers in hospital, but he was being comp'd a little. I
believe her pain was from surgical adhesions. The nipple had been
completely removed during the reduction surgery. 

Baby had to be held very close onto the sandwiched breast. It's like he had
to think about what he felt, then responded with a strong Hoover vacuum
latch. Her nipple shape was unchanged after babe released the breast. Mom
really wanted Breast-only. Recommended mom to read West's BFAR book.

OB nurse and Nsy nurse were surprised at what I found. Documented same in
baby's chart to be sure the Pedi's get this info. 
 
Any chance this mom's pain will lessen with time? Any suggestions for when
I see this again?
Thanks.
Phyllis



> Oh, this reminds me.  Why didn't the OB see this?!  Don't they check
women's 

> breasts anymore?   

--- Phyllis Adamson, IBCLC, RLC
--- Glendale, AZ, USA
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