> Hello,
> Lactnet has provided me with invaluable learning for the past many years. Today is my first post. I have PTP. First child born at 32 weeks, with a long NICU stay. Mom provided EBM for her premie baby in limited amounts. She could never pump more than one oz at the time. She was told over an over to try harder, pump more, etc. Her second pregnancy was normal, delivering a full term healthy 7 lb 3 oz baby. Mom's breastfeeding expectations were pretty high at that point. She exclusively breastfed in the hospital where things appeared normal. Once she got home, things changed, she could not console the baby despite having her at the breast all the time. That's when she called me. As I visit with her I'm listening to her story, asking lots of questions; she starts sobbing, letting her emotions flow and expressing how for the first time someone is listening! Her  breasts appearance was far from normal. Very small, semi tubular just because the nipple seemed to protrude more than the breast itself, specially in the lower quadrant area. Nipples were puffy, super sensitive with a deep compression mark in the middle. Breasts felt full, able to manually express some milk. Breasts in general were painful. Her history is complicated. High performance athlete from young age, poor body image,eating disorders in college.
> Baby, a beautiful very hungry baby. Her tongue has a posterior restriction, very little elevation, an anterior dimple and a hunch in the back. Latching is very painful even with a deep asymmetrical latch. Baby sucks eagerly, at times some nutritive suckling is observed. Weight tests are in the negative!
> Need to feed the baby! Baby took 50 ml from a ready to feed bottle mom had from hospital.
> I'm hoping to gain some perspective with your comments. Parents were not receptive to have tongue evaluated or treated. Supplementing at the breast is almost ruled out due to nipple pain.
> Scheduled pumping and maybe use of herbal galactogogues to help with supply is considered but mom recognizes that taking care of 22 month old, new baby  and pumping may be too much to ask.
> As of last night mom reports excruciating pain when trying feeding at the breast. Pumping according to her is not much better. She reports experiencing the same kind of pain/tenderness all over her breast when pumping for her premie. I suggested to pump only -still using her old PNS- very low setting, heat prior to pumping and continue with pain meds. I'm hoping that once the cycle of pain during breastfeeding is broken, pumping could be tolerated. She asked if she should stop trying. I  have trouble explaining the reason for her breast pain. She is willing to pump a few times a day to keep the little milk she has and hope for one breast milk feed a day. I will be talking to her later today.
> Thanks for listening.
> 
> Rosalba Gutierrez MS, IBCLC
> www.completebreastfeedig.com
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> Kathleen B. Bruce RN, BSN,  IBCLC
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> Lactnet listmom
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