I would say, try to get the baby off the nipple shield by doing some hand-expression, even pumping for a minute or two, followed by hand-expression and change positions with the baby more prone.  This baby is only 12 days old.  I have found that if you don't protect supply while using a shield, the supply will start tanking at 2 weeks or so.  Remember the nipple shield reduces baby's vacuum by about 40 mmhg (this is from my own research, nothing published).  Thus, when mom has a milk ejection reflex, some of the milk may move back up into the ducts, thus causing breast pain, possible plugged ducts, and eventual reduction of supply.   I would advise her to pump after feedings for 5 minutes or at least hand-express both breasts after feedings until baby is off the shield.  



-----Original Message-----

From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Jesica Miller

Sent: Tuesday, December 23, 2014 2:20 PM

Subject: Engorgement question



I am working with a mother that is about 12 days postpartum and still struggling with engorgemebt.  She has given me permission to post.

Her baby is drinking approximately 1.5 ounces when she breastfeeds with a nipple shield.  Mom has stopped pumping because it seemed to make it much worse.  She has tried using moist heat before feeding, massage during, and frozen peas after feeds.  She is taking her Motrin.  

She pumped to completely empty twice.  Each time yielding 7-8 ounces total after the baby nursed.  She has tried drinking a few cups of sage tea.  

Any suggestions would be appreciated.  The engorgemebt is improving.  It was very severe when I first met her.

Thanks in advance!

Warmly,

Jesica Miller RN, IBCLC



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