There is a patient on our maternity unit who I have ben following since
she had her baby via C/section 5 days ago.  Despite almost constant
nursing, with good latch-on and positioning, her mature milk does not
seem to have come in and the baby cries and shows feeding cues after
each breastfeeding session.  (mother nurses at least 20 minutes on each
breast)  Beginning at about three days of age the baby has been given
supplementary formula after he nurses.  The interesting part of this
story is that the mother has a history of considerable nipple damage
when she was sexually molested about 10 years ago.  At that time she was
told by her doctor that because of the damage, there was no way to know
whether she would be able to breastfeed, and she would just have to wait
and see. And, just to make things even more complicatd, she is now
running a fever, and the incision is somewhat reddened, so she is on IV
antibiotics.

My questions: could nipple damage of this type be responsible for
delayed milk production, or wouldn't the milk continue to be produced
but just not be able to be accessed easily by the baby?  The mother had
no engorgement or other evidence of the milk coming in.  Should I have
her pump, or just continue to nurse frequently and supplement as
necessary?  I am concerned that more interference and focus on
interventions will just continue to increase the already extremely high
level of stress, which in itself may be a factor in the delay in milk
production.  Also, is it possible that whatever infection is present and
causing the elevated temp may in some way be affecting milk production?

I would appreciate any thoughts.  I will continue to follow this mother
after discharge.

Thanks in advance for any assistance.

Lori Lerman, R.N.