Good morning Wise Women,
P2P
I have a 41 year old woman who is 38 5/7 weeks pregnant and is scheduled for a c-section at 39 weeks due to 3 hernias and back issues. This is her first pregnancy. She has a history of IVF, gastric bypass 3 years ago, and bilateral breast biopsies at age 20 for lumps and her mom was diagnosed at 41 with breast cancer and died at 45. My clients' diagnosis was benign fibroadenomas. She had 1st and 2nd trimester breast tenderness, now none. She has scars around her areola that go 1/3 the circumference of her areola. She is able to hand express colostrum in both breasts. She does not have veining nor has she experienced a cup increase in her bra size. Her bra size went from AA to B at her heaviest weight and then went back to a AA post gastric bypass and she is still able to wear her pre-pregnancy bras although she reports that they "feel a bit tighter." The skin on her breasts is very loose and there is not much breast tissue.
"Up until the last year I had really regular periods, and in the last year before pregnancy the became more like a 32 than a 28 day cycles, but even then still came monthly, no skipped periods. I had to stay on hormones, progesterone vaginally, progesterone IM injections, and oral estradiol, and then at 10 weeks tapered off all of them completely and had no hormone supplements for the rest of the pregnancy. I'm not iodine deficient, thyroid is fine, and I take B1 100 mg and two MVI daily, plus B12 2500 mcgSL three times a week, and my levels are great, they just got tested 2 weeks ago. I'll get the hospital grade pump before I leave the hospital if I can, I have three days to get it. I don't notice any loss of sensation changes so that's a good sign. It feels the same all over the nipple and areola."
I encouraged her to do lots of s2s, read cues, offer frequently, discuss with her doctor about hand expressing and storing colostrum starting last Sunday in the event the baby needs supplementation. We also discussed galactagogues, eating well, and resting. I would appreciate any advice you have on our plan to maximize her milk production.
Lisa Meyer-Jones RN, IBCLC, CLE, LCCE
Started in PP last December
San Ramon, CA
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