Friday as I was leaving work, I was asked to go in to speak to a mom who
had just delivered 33 week twins by CS.  She had just come in from
recovery and wanted an idea of when and how to begin pumping.  I gave
her a pumping plan and told her to begin when she felt ready, preferably
as soon as possible.

Today I met her in the NICU and she said that she was not able to get
any milk out of the right breast, but the left breast was producing the
amount she needed for the babies.  I asked her if she had had surgery on
the right breast and sure enough, 8 years ago she had had a cyst
removed.  The scar was around the areola from 5:30 to 1:00, and I was
not able to express even one drop of colostrum from that breast.
Neither warm compress nor ice pack  helped.  She had early signs of
engorgement on that side and  general tenderness there.  There was a
lesion on the nipple from pumping.  The other breast was less engorged
and the nipple was undamaged.

What would you do wise ones?

1.)Has anyone had a twin mom breastfeed using only one breast?  I have
had  singleton moms do so with no problems.

2) Why don't we have at least one quadrant of the ducts functioning?
She said that the cyst was about one cm in diameter.

3) Should I photo this?  I didn't want to ask  her today because she was
in so much pain both from the op and the engorgement.

I explained the aesthetic aspects of asymmetry which did not bother
her.  She said that she did not intend to breastfeed for very long (
many  preemie moms say that and then go on to nurse for years, so I will
not touch the duration issue at this stage).

I suggested that she continue to pump on the side that is producing
normally and start cabbage leave treatment on the blocked side with
intermittent  ice packs. How long can I expect the reabsorption to take
given that there is no outlet for milk?

The mom seemed a little  overwhelmed and weepy today from pain and
stress, so I just want to take it slowly with her, one step at a time.

Any idea for protocols for unilateral nursing of twins.  One will get
the fore milk and the other the hind milk and then next time they will
switch?  Pre-feed pumping?  We have time before they go to breast so
any  solutions would be greatly appreciated!!!  She has tons of
colostrum, so supply shouldn't be a problem.

Ten more days till I leave for Toronto ( of   course I will go visit
Jack) and then Phoenix!!!  any brave souls want to fill in for me while
I am gone?  There were 150 births since Friday.  I had to do two classes
this morning of 35 dyads each, and still didn't get to everyone.  But
every baby ate, even if two were spoon fed!!  Can't win em all!!

Esther Grunis, IBCLC, feeling fulfilled, but frustrated in my much less
formula friendly hospital, and badly in need of my upcoming vacation.

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