Val:  We had a run of pp hemorrhages in the past few weeks at our local
hospital (what are they doing to those cords in L&D????)  with 2 that ended
in a need for complete hysterectomies.  One was extremely severe and mom
almost died - interesting aside note:  She had a history of primary
infertility, had surg several years ago related, they nicked her iliac
artery and she almost died then.  Infertility treatments thru the years left
TONS OF ADHESIONS internally.  After this healthy 9lb+ boy was born
vaginally last week, the abdominal adhesions would not allow her uterus to
involute and she came horrendously close to completely bleeding out.

We were quite daunted by her infertility & pp hemorrhage, but adopted a
wait-&-see approach as we use with moms who have had reduction mammoplasty.
But it gets better, she also had extremely flat breasts & absolutely NO
AREOLAE!  Nipples do stand out quite nicely though.  They did somewhat look
like pubescent breasts but the nipples looked well developed post puberty.
Mom first put baby to breast early on day 4 pp.  The nurses had been finger
feeding up to that point.  I'm not totally sure whether or not he had any
artifical nipples.  Baby was a fussy guy (probably scared to death for his
mama!) but did latch intermittently.  I think he sensed mom's overwhelmed
emotions.

On day 5 pp her milk came in - nice fullness bilaterally & quite easy to
hand express.  With this fullness it seemed to us that she just has very
little supporting breast tissue - it feels mostly glandular.  Baby is now
latching more regularly with great suck & audible swallow.  We also
introduced an SNS at the pedi's request.  He is now totally fed at the
breast.  She is also doing every other day wt. checks & concurrent reduction
of supp in SNS if appropriate.  Our fingers are crossed.

I really feel that the wait-&-see with careful instruction & follow up are
important.  For supps, I'm not sure why you would dilute the formula?  Has
mom pumped?  Is she feeling well?  Getting rid of any & all artificial
nipples & doing supps by cup or finger feeding may help.  Lots of skin to
skin contact would be beneficial too.  Best of luck!
Debbie Shinskie RN CES IBCLC in Millersburg, PA, USA
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"The cure for anything is salt water - sweat, tears, or the sea."
                                                -Isak Dinesen