I have permission to post. A mother with 4 week old premature triplets who are
still in the NICU is pumping every 3 hours and had a very good milk supply. She
over slept one pumping session and her breasts became very engorged. Her right
breast recovered well, her left breast however did not do so well. She had
plugged ducts that have been difficult to relieve. Now when she pumps she is
getting 50 ml from her left breast(was getting over 100ml) with only one let
down with some spraying. She still has plenty of milk left in her breast but she
cannot get it out. Her nipple swells into the 30mm flange and seems to impede
her milk getting out of the ducts. The only way she can relieve it is to lean
her breast into a basin of warm water and with massage she can get more milk
out. It sprays from 4 t o5 ducts and her breast soften some though there is
still  more milk in her breast. The nipple swelling reduces while in the water.
It seems once her nipple swells she cannot get anymore milk out. I am at a loss
as to how to advice her. She is losing all the milk she is expressing in the
water and she has three babies to feed. She cannot get the milk out by hand
expression without the water
I am thinking maybe I should tell her to stop pumping on the left and just hand
express in the warm bath so maybe her nipple can recover.

I wonder if anyone has had experience with this and I would appreciate any
advice you may have.
Nuala Murphy RN, IBCLC

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