I am a Licensed Midwife and an IBCLC.  I am working with a mom who had been planning a homebirth with me and ended up with a c/s 4 weeks ago for non-reassuring NST and BPP with very low AFI.  Baby was healthy and well at delivery.  Mom tolerated surgery well.  She established breastfeeding in hospital very well.  Birthweight was 8#10oz.  She was discharged on Day 4 with a weight of 9#1oz?  I saw her the next day and got a weight of 9#0oz.  

Starting on Day 5 to this day (Day 29), she has complained of nipple pain and discomfort, inability to empty breast.  The baby had a tongue tie released at Day 8.  The mom suffered an allergic reaction to the steri-strips resulting in ulcerated lesions.  She has had postpartum PUPPPs, for which she took 48 hours of full dose Benadryl.  She has used nipple shields and hasn't used nipple shields.  On Day 23, the baby was 9#5oz.  She reported he wanted to feed all the time.  I suggested 10 minutes per breast.  10 minutes pumping both breasts.  And dad giving supplemented pumped milk while mom pumped.  This was unsuccessful for her, and she was unwilling to continue past one or two feeds. 

She has made a couple trips to my office for LC help with latching and assessment.  I'm confident the latch is great at the office.  

She is currently 8 hrs away from me on vacation, but 2 days ago complained of pain on letdown and an inability to evacuate milk from breast except by hand in the shower.  I rec'd she see an urgent care doc who Dx mastitis and Rx'd abx (yesterday).  She is now in bed with sore throat, fever, chills, and exhaustion.  Unable to get adequate letdown, except in shower with warm water.  Baby still wants to feed all the time.  Breasts still feel full after he feeds.

Since her discharge from the hospital, there have been virtually NO days where this mom has succeeded at just being with her baby.  She has sought the care of a number of different LCs.  No suggested interventions have seemed to work for her, as far as getting the baby to transfer milk efficiently and gain weight.  He does have several BMs and wet diapers daily.  The baby has that typical worried look of a stressed out baby.  I'm getting stressed out, too!

Help.  I'm not sure if this is one for psychological intervention -- it's feeling that way.  She seems very uneasy and is not at all adjusting to motherhood well.  She has a profession in the mental health field, so has been unwilling to accept up to this point that she might need outside help.  

I need some suggestions.  I'm running on empty with her.  She seems to need so much, but doesn't take the suggestions offered, and then just shops other providers for suggestions and recommendations.  

I'd like to get the baby feeding comfortably and well.  I'd like the nipples to not be sore anymore.  I'd like the breasts to empty on feeding and for there to be a more established feeding pattern than just all the time at the breast.  This mom needs a break and so, too, frankly does this LM, IBCLC.  

Any feedback welcome.  Thanks in advance.  

Megan Bochum, LM, CPM, IBCLC
pacificmidwiferycare.com

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