<  I asked mother if back of
breast was always hard like that, she said no.  However, she reported to
feel no difference pre and post feed.
We started her pumping with a Lactina. . . .  She pumped every 2-3 hours
and was getting 5-10 cc each time
for about a week.  She then switched to a Avent hand pump, and has been
getting about 30 on one side, and still 5 on the other.  Same pumping
stimulation.
I asked her again maybe something she left out in History... Thyroid,
Placental fragments, (she is not bleeding anymore).  But she did say when
she was about 12 she ran into a bannister and severely banged that breast
(the same one that is barely producing) and was in major pain for at
least
a week.  Can this be related to the small output?  Why is her other side
not producing more?  Why was the Lactina not working?  Has anyone ever
seen
anything like this?>

I'll take a stab at this, Jessica. You seem to have taken an excellent
history.

If back of the breast is newly hard, that sounds positive. If she is
"largish", by my observations and reasoning, (others disagree, saying
this is not yet evidence based) she may have longer ducts in general.
This would result in slower transit time to the front of the breast at
the beginning of lactation, simply because of the longer distance to
travel.

Have you tried breast compression during a feed, during and before and in
the middle of pumping? Is her let-down conditioned yet? This would be a
good place to start-massage, imaging, backrubs, fingertip expression
before feeds and pumping to trigger the MER. Don't expect to see results
for a full 4-5 minutes if the mental/emotional aspect has not been
conditioned yet. The hormonal arc takes time to end up with the emergence
of milk from the nipple.

MER is the major force in milk removal, not the pump. The pump only pulls
on flesh. It does not pull on the milk except that milk which is one
small component of the flesh near the bell of the pump. The milk has to
be close enough to the bell of the pump for the negative pressure drawing
in the nipple and areola to result in positive pressure of the resistance
of the inner rim of the bell on the milk sinuses.

This causes milk to be extruded like toothpaste from a tube. When it
exits the nipple, THEN the vacuum pulls directly on the milk. There are
mothers whose milk sinuses are deeper. IME, a larger flange, even the
biggest glass one made, has been successful for at least two of the
mothers I have used it on.

When you get the milk moving away from the alveoli and out of the breast,
that may answer your question of why production is low. Milk removal is
the major stimulus for milk production, even at this stage.

As for the injury when she was 12. Perhaps some scar tissue in some
ducts. But alveolar tissue builds slowly as result of stimulation of each
menstrual cycle during puberty, and then, of course, much more during
each pregnancy. It doesn't seem to me that incident in early puberty
should have much effect. Child hood x-ray treatment for thymus, etc.
would probably be a different story.

Perhaps the tincture of time along with what's already been tried, will
work. I recommend Diane Wiessinger's handout "The Labor of Nursing" to
address the psychological aspects.

Jean
***********
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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