Hello Lactnetters,

Permission to post.

I need your help with a client:
30 year old primipara with 8 day old term baby girl, NVD, (had pitocin and epidural) hasn't been able to let down. Milk came in on day 3.

Baby latched on in hospital but has very tight latch and started breaking down mom's nipples almost immediately.  No tongue tie, normal palate, good rotary suck.  Baby had been refusing breast so mom is pumping q3h 2-3 oz.  Nipples are damaged from pumping, both at tip and at friction zones, using mupirocin.  Suggested olive oil on friction zones of flanges today.  Tried latching today with nipple shield but too painful for mother.

Mother has history of painful fibrocystic breast disease prior to each menses, no surgery, which subsided during pregnancy.
Breasts are large, engorged, with some axillary distention on right, shiny, no mastitis sxs, some full tender ducts after pumping, esp on right.

Pumping takes 30-60 minutes at a slow drip to produce 3 oz with massage.  Flange sizes are correct size for her (27's)  and suction is set at 3 (she starts at 1 and advances it until it is one click less than painful) on Symphony pump.  Left produces twice as much as right and is larger.

Baby is back to birthweight already and growing nicely.

We have tried skin to skin, relaxation, visualization, warm showers and compresses, ice in between, advil, hand expression, even synthetic oxytocin nasal spray with no results.

I have suggested CranioSacral Therapy for both mom and baby.  Considering ultrasound Physical Therapy for her tense, full breasts which may help in the short term until she fills up again but I need something to help this woman consistently with her letdown.  I believe that pain is a powerful inhibitor of her MER and want to limit the pumping to heal those nipples, but not reduce her supply in this critical period.

Looking for your collective wisdom.

Thank you,
Annie Brown, FNP, IBCLC, LLLL
Greenwich CT

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