Hi Dawn   I would have her try ice instead of heat and reverse pressure 
softening.  Make sure the vacuum is low on the pump.  Carolyn Schindewolf, 
IBCLC
----- Original Message ----- 
From: "Dawn Burke" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Wednesday, December 12, 2007 10:30 PM
Subject: only right breast engorged


> I'm posting to two locations; please pardon if you get this twice.
> I have the mom's permission to post.
> I received a call today from a mom with a newborn.  Baby born Dec 8 at 7 
> lb
> 1 oz, 41 weeks. Weight on Dec 10 was 6 lb 9 oz.
> Mom was induced.  She has anticardiolipin antibodies (has had three
> miscarriages) and has been on heparin for the past nine months-- still
> taking it.  (I've worked with this lady's sister, who has rheumatoid
> arthritis).  She had not gone into labor at 41 weeks, so was induced "from 
> 0
> centimeters".  Baby born vaginally but with lots of tearing, mom
> had epidural.  Baby stayed a couple of days in hospital due to high
> bilirubin counts.  Received some supplementation since baby had two wet
> diapers in 3 days with mom nursing very frequently.
>
> Mom says her right breast feels "locked up".  Baby is nursing just fine 
> from
> left breast, but doesn't seem completely satisfied after feedings. Mom
> thinks baby may still be losing weight, or at least not gaining. She has
> started a small amount of supplementation (formula) but is aware that she
> needs to pump as well.  She is following up with HCP for bili levels, so
> baby is being seen regularly for now.  Since being home, mom has been
> nursing every 2-3 hours.  I discussed lots of skin-to-skin to encourage 
> baby
> to nurse more frequently and build up milk supply in left breast.  Mom 
> likes
> to nurse lying down since she has too many stitches to make sitting very
> comfortable.  Her right breast is getting quite engorged, but she is 
> unable
> to express more than a few drops with a Medela Advanced PIS or by hand. 
> She
> did get fitted for larger pump flanges, which she says are more 
> comfortable
> but she still can't pump more from the right breast.  Baby will not stay 
> on
> right breast and gets very frustrated.  Mom has no past injury or surgery 
> to
> the breast.  She has tried hot compresses, breast massage while in a warm
> shower.  Nothing seems to get the milk out.  I encouraged her to keep 
> trying
> to pump and do skin-to-skin; if she gets really uncomfortable, to try
> cabbage leaves as well.
>
> I asked if baby has been checked for tongue-tie and she thinks not.  She
> says the baby will sometimes clamp on her nipple very hard.  HCP says this
> could be from baby's high bilirubin (?) and the baby may have a "tense 
> jaw".
>
>
> Any suggestions?  I'm thinking a plugged duct would be more localized and
> she'd be able to express some milk. Could the anticardiolipin contribute 
> to
> this, even while she's on heparin?  It sounds to me like baby isn't 
> latching
> effectively (I did discuss letting baby self-latch with sts, and also
> discussed helping the baby to an asymmetric latch).  Baby could be 
> clamping
> due to tongue-tie or not feeling well-supported during feeding or....?
> Mostly I'm just really puzzled about the one-sided engorgement-- what 
> might
> cause it and what to do about it.  Any info is greatly appreciated.
>
> Dawn Burke
> LLLL, Georgia
>
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