I have seen a few mother s like this right before discharge from the hospital.
a few thoughts:
1. maybe she needs an even bigger flange since you said her nipples were large
2. hand expression
3. cabbage leaves
4. cool compresses for at least 10 -15 minutes.
5. single pumping with massage alternating breast every 5 minutes.
6. no heat at all since the milk is not releasing.
Tamara Hawkins IBCLC nyc
"Chris Smith, RN, IBCLC" <[log in to unmask]> wrote:
Permission to post from a NICU mom I am working with. G1P1 who delivered a 30
week premie by vag delivery on 6/1. Started pumping with hospital grade pump
on1st PPD at delivering hospital. Milk in on 6/4. First saw in NICU on 6/5
with severe engorgement of both breasts, red areas, no fever and only able to get
drips out with pumping 10-15 minutes of double pumping. No obvious edema of
breasts. 30 mm flanges given as nipples were obviously too large for 24mm
standard flanges. Warm compresses applied before pumping and ice packs afterwards.
Only able to obtain 10ml from left breast. Denies breast surgery (reduction,
augmentation, chest tubes, chest trauma), meds or medical conditions that would
affect. Instructed on Monday to use hot compresses or hot showers before
pumping, ice afterwards, double pump (has rental pump for home use) 8-10x/24hrs
for 15-20 minutes. Saw today, breasts still almost as hard as Monday. Has been
using heat, ice packs faithfully for most pumpings and averaging 7-8
pumpings/24hrs. Maximum obtained is 20ml with little/no relief of pain/engorgment.
Suggested cabbage leaves today as well as relaxation techniques,
Tylenol/Advil before pumping for pain relief hoping it will help relax her. Doesn't matter
if she pumps in the pump room, at bedside or at home. No change in what she
is able to get out. She is only getting 3-4 drops from right breast and
remainder from left.
Any other suggestions or ideas? This mom is miserable and I am afraid we are
going to permanently affect milk volume if we don't get it resolved soon, and
it may already be too late.
Chris Smith, RN, IBCLC
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