Ann, I don't think that it is unusual for a mom's milk supply to come in
later when she has had a difficult birth.  She may have had a lot of IV
fluids which are causing a swollen areolar area. I have seen delayed milk
production in mothers with a lot of IV fluids on boards, and in those who
have had a lot of medications, etc.

Frequent gentle pumping would be a good idea. Make sure she does not have a
retained placenta. Kathleen

At 2/5/2002 08:05 PM -0500, you wrote:
>I need help from all you Wise Ones.
>
>I am working with this woman, first baby, 34 weeks gestation.  Delivered on
>2/2 vaginally with epidural then pitocin to augment the labor.  Her only
>complication from the delivery is severe hemorrhoids.  She is Indian and her
>husband stays with her, assisting her with everything.  She appears educated
>and speaks English well.
>The baby is in a level II nursery due to his immaturity and still does not
>have a coordinated suck/swallow.  On 2/4 they placed a feeding tube to help
>give the baby his feedings.
>The mom had breast changes during pregnancy and when I saw her for the first
>time on 2/4 I could palpate milk production.  The breast are moderate size
>with very firm areola and nipples.  When I had the mom hand express her
>nipples which are slightly everted, they flatten and even appear to look
>inverted because the areola tissue comes up and around the nipples.
>Here is my dilemma: I had her hand express on both nipples and there was NO
>sign of milk.  Then I tried (which I do not like to do because of discomfort)
>but I wanted to show her some milk -- nothing.  Not even dampness.  I set her
>up with a double electric breast pump and there has been no sign of milk in
>the flanges yet.
>I assisted her with the baby and ended up with a small nipple shield so the
>baby could latch.  There has been very little sustained sucking from the baby
>and no milk transfer.
>Today I saw her and the breast are fuller but no milk from her efforts.  She
>has had no surgeries or problems with her breast.  Her mother breastfeed
>without any difficulties.  She says the hemorrhoids are painful but she has a
>stoic face.
>Her nipples almost appear tough like s/p radiation therapy to the skin.
>My impression is a problem with letdown or some very bizarre nipples.
>Any help would be appreciated.
>Thanks,
>Ann Perry RN, IBCLC
>Boston, MA
>
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Kathleen B. Bruce, BSN, IBCLC co-owner Lactnet, Indep. Consultant
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http://homepages.together.net/~kbruce/kbblact.html
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