Mary Kay states: "My fiasco of the week was this scenario and she's having a
hell of a time at home....."

I wish we were closer and I'd be able to do a consult for this gal to resolve
her engorgement and get a proper latch.  It looks like she'll need LC
"hands-on" interventions to overcome her issues or she won't be breastfeeding for
long.

In addition to the already mentioned comments regarding pitocin and
engorgement.  Remember that these swollen nipples are usually seen after a failed
induction.  Most of the time an induction is scheduled, unfortunately too often for
no medical reason, and thus the cervix isn't ripened, so the induction fails
after several long hours of labor, of which the IV fluids are running in and
overloading at the cellular level as has been mentioned here before.  Then the
body compensates by "shutting down" to recover from the fluid overload, and we
have a delayed lactogenesis.  I see this way too often around me.

As Nancy Wight mentioned about the induction of twins, most of the time
inductions are scheduled without a true medical necessity.  There is no protocol in
the perinatalogy literature as I recall that states to automatically induce
twins at 38 weeks.  The guidelines dictate assessing the condition of the
baby(s), and promote maintaining the pregnancy for the duration of gestation if
baby(s) status are not compromised.  What's a compromised baby?  A baby not
adequately growing inutero.  What relevance does this have to breastfeeding?  A
baby born too early, when not ready, may suffer respiratory compromise which
impacts its ability to breastfeed by 1.)separation from mother, 2.)lack of
skin-to-skin, and 3.)I promise to stop here and not go on and on.

But, since this is off the subject matter of Lactnet, if anyone wants further
information on guidelines for inductions, I believe I can find some
literature for you if you e-mail me privately.
Carol Chamblin, RN, MS, IBCLC
Breast 'N Baby Lactation Services, Inc.
St. Charles, IL

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