Hi, I should just introduce myself. I am a lactation consultant & childbirth educator in Kuala Lumpur & I appreciate all the knowledge gleaned from reading lactnet.My main interests are in the effects of birthing practices on breastfeeding & have been working for many years trying to get moms more choices in birthing. Way to go yet. So pleased to see WABA taking this up!
 I would like a little help on a mother I saw this morning. She is aware that I am posting.
I saw this mother for the 1st. time today. Baby is 10 days old - forceps delivery after mom was on epidural for approx. 4 hours. Mom has flat but protractile nipples on both breasts. She breastfed for 1st 4 days & was told by visiting midwife that attachment was OK but according to mom's description baby only stayed attached for a few sucks.  Following engorgement day 4& 5 baby has refused to suckle on the breast. Mom has been expressing & feeding by spoon, syringe & twice a day by bottle.
She is able to express approx 50-60ml from left breast using Avente pump but 10ml only from Rt. breast. We tried using Lactina with similar results & then tried manual expression on the Rt. breast. This resulted in very slight milk flow from the nipple itself but a small amount of  milk was leaking from ? the montgomery's tubercles about one inch + back from nipple.
This lady is Canadian. She has a sister who gave birth in Canada & was seen by lactation specialists but was never able to achieve sufficient milk supply to feed her baby. She is obviously concerned that she will have a similar problem.
Baby cries & becomes very agitated when put to the breast. Purses lips when syringe fed. Refused the cup. Wondered about finger feeding but baby will only suck on moms knuckle & pulls back at any attempt to put a finger in her mouth otherwise.
Suggested that for now she makes breast a comfort zone rather than pushing baby to feed & distressing both of them.Also if using a bottle to use a slightly longer teat with slow flow. I would like some advice on best way to stimulate milk flow on the right breast & also suggestions on how to manage this once baby starts suckling on the breast again as the baby's lips will definitely not cover the part of the areola from which the milk was leaking. 
Very grateful for your suggestions.
best wishes,
Christine Choong

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