I would say this sounds like a pretty typical case of what I work with when 
it is a long induction and epidural. Babies are very sleepy and may latch on 
but rarely suck actively enough to transfer milk. I bet there isn't alot of 
swallowing going on and this is one baby who is "content to starve" and 
still very sleepy. I've also seen lots of these long induction babies who 
have disorganized sucking patterns and can't remove milk well.

The nipple scabs sound like baby is not latched on correctly or mom is using 
a bad breast pump. If baby is only on the tip of the nipple, the milk 
transfer is usually poor and mom gets tissue damage. I also see alot of 
babies with tight mouths or who clamp their jaws in these situations.

When moms are very edemous they often are slow to make copious quantities of 
milk. Sometimes a pump with LOW suction is better than using higher suction. 
Sometimes the older style of piston driven rental or hospital quality breast 
pumps works better in removing milk than the computerized ones (for some 
moms). I would want to know if the hardness is from the skin area (like a 
swollen balloon) or hard lumps from the milk ducts being backed up? or both?

Of course the urine was dark -- based on the 13% weight loss which says poor 
milk transfer. How many bowel movements was this baby having and were they 
yellow by day 3-4?

Also by day 3-4 test weights are very helpful in assessing milk transfer.

Best to this mom. Hopefully a tincture of time will help. Kathy Eng, BSW, 
IBCLC 

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