You inquired about therapeutic ultrasound. I have used this twice for mothers that had unrelieved breast pain. One had fibrocystic breasts and the other had (I believe) no external ducts in one breast. They both had great relief from from the ultrasound. The mothers both felt that the first treatment was not long enough. The physical therapists lengthened the second and third treatments and the pain was resolved. See Jack Newman's recommendations for ultrasound treatments.
Do you feel that this mother has delayed wound healing? Would she benefit from a change in antibiotics? Do you think that her right nipple may be larger than the left and may need a larger flange for pumping? This is one reason that a breast may empty more slowly than the other.
Sincerely, Rachel Wahl RN IBCLC
> Hello Lactnetters,
>
> Permission to post.
>
> I need your help with a client:
> 30 year old primipara with 8 day old term baby girl, NVD, (had pitocin and epidural) hasn't been able to let down. Milk came in on day 3.
>
> Baby latched on in hospital but has very tight latch and started breaking down mom's nipples almost immediately. No tongue tie, normal palate, good rotary suck. Baby had been refusing breast so mom is pumping q3h 2-3 oz. Nipples are damaged from pumping, both at tip and at friction zones, using mupirocin. Suggested olive oil on friction zones of flanges today. Tried latching today with nipple shield but too painful for mother.
>
> Mother has history of painful fibrocystic breast disease prior to each menses, no surgery, which subsided during pregnancy.
> Breasts are large, engorged, with some axillary distention on right, shiny, no mastitis sxs, some full tender ducts after pumping, esp on right.
>
> Pumping takes 30-60 minutes at a slow drip to produce 3 oz with massage. Flange sizes are correct size for her (27's) and suction is set at 3 (she starts at 1 and advances it until it is one click less than painful) on Symphony pump. Left produces twice as much as right and is larger.
>
> Baby is back to birthweight already and growing nicely.
>
> We have tried skin to skin, relaxation, visualization, warm showers and compresses, ice in between, advil, hand expression, even synthetic oxytocin nasal spray with no results.
>
> I have suggested CranioSacral Therapy for both mom and baby. Considering ultrasound Physical Therapy for her tense, full breasts which may help in the short term until she fills up again but I need something to help this woman consistently with her letdown. I believe that pain is a powerful inhibitor of her MER and want to limit the pumping to heal those nipples, but not reduce her supply in this critical period.
>
> Looking for your collective wisdom.
>
> Thank you,
> Annie Brown, FNP, IBCLC, LLLL
> Greenwich CT
>
>
>
>
>
>
>
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> ------------------------------
>
> Date: Sat, 4 Dec 2010 17:13:39 -0700
> From: Phyllis Adamson IBCLC <[log in to unmask]>
> Subject: Re: VRE and breastfeeding NICU baby
>
> What is VRE? It is not listed in Breastfeeding and Diseases by Buescher & Hatcher.
> Phyllis
>
>
> ---- Brenda Phipps <[log in to unmask]> wrote:
>
> =============
> I have searched high and low for references on the issue of whether a mom with VRE can breastfeed her infant (32 weeks) in the NICU. Can someone please update me on the lates recommendations, and maybe even places I can look for references?
>
> Thank you!
>
> Brenda Phipps, BS, IBCLC
>
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> --
> Phyllis Adamson, BA, IBCLC
> Glendale, AZ.
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> ------------------------------
>
> Date: Sat, 4 Dec 2010 21:06:51 -0500
> From: Gail Hertz <[log in to unmask]>
> Subject: Re: VRE and breastfeeding NICU baby
>
> > What is VRE?
> vancomycin resistant enterococcus
>
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> End of LACTNET Digest - 4 Dec 2010 (#2010-969)
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