Dear Friends,
I need your advice.  I worked with a mother yesterday who seems to have no
flow from her right breast.  Here is the history;   This is mother's fifth
child.  All children nursed about 13 months.  Mother nursed her first baby
with no problems until he was 10 months old.  At 10 months she got mastitis
in her right breast.  Since then she has repeatedly had mastitis in that
breast and very little flow.  With her fourth baby, she dried that side up
since the baby was unable to get any milk out and nursed exclusively with
the other side.

Mother had an ideal birth and postpartum experience (as close to baby
friendly as we have here) I can not see any problems with the baby.  Milk
came in on day 2.  Baby nursed well on left side immediately after birth and
through the hospital stay but did not manage to relieve the right side.
Mother tried pumping and got out a few drops.  On the afternoon of day 3 she
called me and began using cold compresses and trying to manually move
the milk.   I saw her on the morning of day 4.  Breast was engorged but not
a total rock.  I could not see anything unusual, shape, size, scars, etc...
Mom denies any injury or surgery on that breast.  Using reverse pressure
softening got a drop of milk out.  Baby was able to latch but did not
transfer any milk. She slips down on that side and the nipple is sore.  We
tried massage before and during breastfeeding.  We used a variety of
positions, including mother on all fours over the baby.  Nothing worked.
Mom tried to manually pump and didn't succeed.  She said that her
experiences with manual expression while leaning over hot water in the sink
or any other way of combining heat and massage has always made the situation
worse.

 On the left side, baby latched on and gulped away and came off
content. Mother was totally comfortable.

I thought about lymphatic massage but could not find a practitioner in the
area.  There was one CST that felt that she could help get the milk flowing
but the mother is hesitant to spend the money and have to go somewhere so
soon after birth. We both thought about the same Chinese medicine
practitioner, who could do acupuncture and tuina but she is away and won't
be back for another week. I also referred mother to a breastfeeding friendly
breast clinic for a look inside.  She is willing to go if it is necessary
but would rather not make the trip if it isn't.  I wasn't sure, what do you
all think?

Mother rented a lactina and began using it.  Last I spoke to her, she had
pumped "40 drops" in 20 minutes.  She said that she felt some relief.  I
instructed her to try the pump or the baby every few hours.  I haven't
spoken to her yet today.

If anyone has any ideas of what to try with this mother, please let me
know.  Also, should she go to the clinic for an ultra sound.  If she is
going to dry up the right side, how can she do it without complications if
she is not able to get the milk out at all, or is a teaspoon every few hours
enough?

Thanks so much,
Chayn Fogelman IBCLC in Israel

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