In a message dated 6/23/03 2:33:37 PM Eastern Daylight Time,
[log in to unmask] writes:

> I'm working with a mom who is having a very tough time breastfeeding --
> started with cracked &bleeding nipples, then engorgement, getting very
> little milk with pumping, not being able to touch her breasts without pain,
> baby still not latching well, although mother is "doing everything right".


Hmm, something happened initially that interfered with milk removal and led
to nipple trauma, engorgement, etc. Sounds as if there's more to this early
breastfeeding history that may still or may not influence the breastfeeding now,
which may in turn still be affecting daily milk production volume.


> Mother is extremely emotionaly labile.  Crying one minute and laughing the
> next.  Dressed for the 1st time at 2 weeks pp.  Shaky, hyper, exhausted.
> We're thinking maybe thyroid now or PPD or a combination.  Mother is
> educated and intelligent, but states that she can't seem to remember
> anything or concentrate anymore.  She is almost obsessive about making lists
> so that she can remember.
>
> I only mention this to say that in her case, not being able to breastfeed
> has her feeling like a failure, and if anything is adding to her distress.
> She admits that she has put her whole self-worth on whether she can
> breastfeed or not.  She knows that's not healthy but she can't stop herself
> from feeling that way.  She agreed to mention this to her OB tomorrow and
> asked me to talk to her OB as well.  In the meantime, she is just pumping
> every couple of hours.  Trying to get the baby to the breast has just been
> too stressful for her.  It doesn't seem that she has any letdowns, so we
> tried Oxytocin spray but little to no improvement.  Still getting drops to
> 1/4 oz each pumping session (3 days of sprays 8-12x/24h).  Do you think she
> could be experiencing PPD?  She's taking Fenugreek and Blessed Thistle (on
> her second day of that).
>

Still sounds as if there is a lot more to her story. It certainly can't hurt
to check thyroid function. Any other aspects to her personal physical and
mental health history that may provide clues to current lactation situation? My
guestimate would be that there are. (I'm assuming at this point that she's using
a hospital-grade, electric pump and a pumping protocol has been provided with
possible revisions as needed?) When I hear that a mother is having difficulty
concentrating or remembering, I do wonder if they may think they are pumping
more often than they actually are pumping...

Does she have someone with her at all times who is willing to help with the
pumping protocol? I'm hoping she has someone with her at all times, as there
could be a safety aspect for a baby left in the care of a mother having
difficulty concentrating, remembering, is emotionally labile, shaky, hyper, etc.

Of course, she could have PPD. She could also have a PP anxiety or adjustment
disorder (and PPD often has some symptoms associated with anxiety disorders),
PP obsessive-compulsive disorder (OCD), etc. She could also have a
personality disorder -- alone or in combo with something else. It sounds as if she
should receive some testing and treatment ASAP. If a mental-emotional issue is
determined, I hope her OB refers her to a mental health specialist vs. treating
her on his/her own. Sounds as if there is more to this story...

Karen (whose MSN is in psych-mental health nursing)

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