Hello everyone,
I had a mom and baby come into my office this morning for a 4 day post 
partum follow up and clearly, the first thing I noticed was that baby was very 
hungry.  Mom and Dad had said all was well up until night before and she has 
since not been able to latch baby, baby crying and obviously hungry.  My 
initial reaction was, well, she's hungry, so lets just start with feeding her and 
then we will cover the newborn exam, etc. and talk whilst nursing...

She explained that she had not nursed on left breast since discharge due to 
pain and nipple trauma.  She explained about pmh of breast cancer and 
lumpectomy on that breast.  Her right breast, which she has continued nursing 
on, she was now unable to latch baby.  When I tell you her right breast could 
be a picture of teaching for areolar edema, I'm putting it mildly.  Not where 
you want to be on day four with a hungry baby.  

So, we tried latching, next to impossible.  We tried reverse pressure softening, 
but the baby was so hungry and upset, she was not having going back and 
forth.  I ended up teaching hand expression and expressing into a sterile urine 
cup and cup feeding her infant about 50ml.  I am lucky to have a great doc 
who is a good friend and trusted me enough to let me spend the time in 
getting the baby fed without supplementing, seeing as she was down 13% 
since birth.  However, mom has milk, so why would we supplement with 
anything other than EBM.  

So, I'm seeing her at home tomorrow.  She is now a little better on track after 
teaching, however I'm still concerned.  She had said that her left breast, with 
the surgery and cancer had radiating pain initially postpartum.  I'm thinking 
this is because the baby was latched wrong, but is there anything I should be 
concerned with otherwise?  I've got her first hand expressing or pumping as 
needed to feed the baby if she is unable to latch and doing either cabbage or 
cold compresses between.  Can I be recommending anything else?

Thank you to any of you who made it to the end of this LONG note!

Laura Miller, RN
Connecticut

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