Here are the things from your post that seem to go together:
<<difficult latch due to engorgement / weight gain issues/ still a puzzle.
persistent pain, in nipple and in breast,/pain on pumping.
impatient with suckling when there was no milk flow./ tiny blood blister /
Possibly blanching/ gained 3 ounces in a week when exclusively
breastfeeding --feeds 7 times per day.>>
So, I am thinking a subtle tongue tie or posterior tongue tie, which would
explain difficult latch and engorgement, weight gain on the low side, trauma
(although minor) and pain and blanching. So I would try to refer her to
someone very adept at evaluating and treating tongue tie. I think the pain
with pumping is because there is already trauma, and I think the reason she
has problems in only one breast is because of a variation in her anatomy or
in the way she positions on each side. In the meantime, she should feed more
frequently if she can tolerate the pain, use analgesics, maybe feed from the
"good" breast only, pump the painful breast during feeds to help with the
flow, or use handexpression which is likely to be more comfortable. Has she
tried supplementing at breast with a tube device? If she is going to
supplement (preferably with own ebm) this would allow the flow to be faster
and perhaps decrease the pain. Moms I work with do all seem to like the
hydrogel dressings or pads when they are in serious pain.
Possibly just by increasing her production, the milk will flow better, and
this might help baby, he may be sucking very hard. Did he take 72 mls from
one breast or after both sides? If from one breast, I wiould say this is
good production, if after 2 breasts, it is not necessarily low production,
but would be more of a concern in light of all the factors.
Hope some of this is helpful to you and her.
Laurie Wheeler RN MN IBCLC
Mississippi USA

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