Hi all you knowledgeable Lactneteers,
I saw a client yesterday that has me totally stumped. Mom delivered without
complications at 36w vaginally, currently only taking Percocet PRN, nothing
else. Mom's lochia is still quite red, but decreasing and changing color.
Mom noticed "very little" breast change during pregnancy, maybe an increase
one cup size.
dd weighed 6# 10oz. at birth and has regained birth weight only thanks to
supplements. Baby latched on and nursed beautifully from 30m>delivery until
mom's milk came in the end of d2. Baby was under bili blankets d2-3 but
parents stayed with baby in hospital and breastfed around the clock. Baby's
palate, tongue movements, and tongue extension are WNL and baby has a
wonderful, powerful, organized suck -- exciting for a baby supposedly 36w.
Mom said breasts were soft until milk arrived on d3. Now mom's breasts are
not large but they are thick (if that makes sense) and feel engorged. Mom's
areolar tissue is so firm, reverse pressure softening and pumping do little,
if anything, to soften. Firmness to tissue returns within minutes of RPS or
feeding, assuming we're even able to get baby latched on. Nipples are soft
and slightly flat but respond to stimulation. Mom's areolar tissue is as
firm as the breast behind it, so baby only sucks on the soft nipple (ouch).
Mom started pumping on d3 with Ameda Elite and she says flanges fit nicely
without being too tight. She has been pumping every time they feed the
baby, which is every 2-3h around the clock, and has only expressed a total
of 10cc from both breasts. She's done warm compresses, massage, relaxation,
the whole nine yards, with no change in amount.
During our consultation, I had her pump using the Medela Symphony, hoping
that the pump she rented was defective or just didn't work for her. The
only improvement I could make was switch the standard 24mm flange to a 27mm
flange on her L breast. She pumped for over 10m and received 6cc total from
both breasts, despite not having any milk removed from her breasts in over 3h.
I'm having the mom pump q2-3h during the day and 1-2x/night and taking
herbal galactogogues, feeding baby her expressed milk first and topping it
off with whatever amount of formula the baby desires, using paced bottle
feeding.
Does anyone know why this mom's breasts seem to have lots of milk but won't
give it up? This one has me scratching my head, not knowing what to try
next. I would so greatly appreciate any suggestions any of you could
provide on this mystery. Thanks a million in advance.
Debbie Gillespie, rookie IBCLC, RLC, LLLL
Tempe, AZ
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