Hello. I saw a mother today, baby 72 hrs approx, back in for feeding
difficulty. I expected to see a hungry baby, unable to latch effectively on
inverted nipples. I saw a hungry baby who could latch and draw out nipples,
but very painful for mother. Baby needed to be fed (> 10% weight loss) so we
started with a pump (Ameda Elite) on one side and a nipple shield on the
other. the nipple shield was a great relief for the mother, no pain, baby
stayed alert and actively suckled for 15 plus minutes, drew milk into the
shield. I was suprised we could only pump scant amounts on other breast,
mother had what appeared to be full breasts, although not distended, still
with some elasticity. Switched sides, same thing, about 1 cc. Okay, its
early in the game and her milk is just coming in now, I thought. 20-30 min
later she told me her breasts feel like rocks, full, distended. so I used
massage, warm wet compresses and the pump again. Again, same thing, scant
amounts 1-2 ccs. Baby back to breast, stays active and alert with shield,
but I dont hear a lot of swallowing....comes off after 10 minutes, hungry.
Now I am thinking this is milk stasis caused by fluid,swelling,pressure on
the ducts, and I am thinking cold compresses, lying supine, however mother
is exhausted now and it is time to go home. I advised her to treat the
swelling and if the milk volumes pumped don't increase over the next few
hours but she remains uncomfortable to call me. she is coming in again
tomorrow for a weight check. So my question is, what would you have done,
RPS? When would you have initiated it? When do you say we have done enough
for now, go home and rest and lets see what happens? thank you for you help.
Nothing like trial by fire-
Kristen Panzer, MS IBCLC
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