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From:
"K. Jean Cotterman" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Fri, 28 Sep 2012 12:47:08 -0400
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Very poignant meditations from this mom at the link provided. It is important to take note of her honest account of her feelings and the effect of her experience on her self-esteem. I was unable to post an answer there except, it seemed, by signing up to become a "permanent member" of the system. So I decided to post my reponse here.

I do in fact have PTP.

A mother who was deciding when to conceive her second child once sought out my advice on avoiding the terrible nipple pain she had had with her first child. She had had no tale of visual damage, but she had decided to EP and bottle feed her first child, and kept this up for 3 months.


After hearing her history, which included intention to have NCB once again, I had her drop her bra flaps (big mistake) and examined her nipple skin, shape, protractility etc. Just to be sure, I referred her to a dermatologist, and he found nothing unusual. I explained to her the common effect that IV's in large quantities often had, and double checked her hand expression skills and taught her RPS just in case.


Fast forward a year or less. I had made arrangements to be called when the second baby was born. She again had NCB, and a fairly rapid labor. She had negotiated with her doctor to have a line in place in her hand if an emergency should arise. He was satisfied with that, and so was she. The baby was born at 2 a.m. and her husband called me at 7, and I was soon at her bedside observing her and her baby. (Her bra was on. Are you beginning to detect my focus here??) Again, she was experiencing the terrible pain, and when I inserted my clean finger into the baby's mouth for a suck assessment, my finger too, soon began to hurt. Long story short, one craniosacral treatment after they were discharged changed all that. I was there to observe it, and I was "converted" from a purely "medical model" of breastfeeding support thereafter.


But the important point I want to make is that when I went to make a home visit on day 5, I found her nursing with her bra off. (Thank heaven! Get my drift??) The pain had left after the CS treatment, but she had felt it necessary to supplement. I immediately noticed that the inner lower quadrant of each of her breasts appeared to be underdeveloped, and there was no apparent fullness there. This had alway been hidden from me when I failed to have her remove her bra for earlier observations. After closer palpation, I explained to her that I suspected insufficient glandular tissue in that quadrant, which I explained was a condition that arose when she herself was in her own mother's uterus, and no fault of hers. I congratulated her on her dedication and stick-to-itivity with her first child. 


I explained that frequency of mik removal was all the more important to stimulate her maximum supply. I taught her about the simple supplementation system at breast that had been developed by Jack Newman. I contacted my veterinarian to buy a sterile catheter of the right size and helped her set it up as Jack explained, and she used frequent nursing, extra pumping and occasional formula using the at-breast supplementer, till she weaned at 18 months.


Several years later, she called me to tell me that she was then 3 months pregnant and was experiencing obvious breast growth and a feeling of fullness in her breasts that she had never experienced before. I told her that the only explanation I could think of was that her persistence with breast stimulation with the second child had somehow lain down many more prolactin receptors in the tissues so that when the new placenta began to stimulate breast growth, she must have started growing more alveoli, etc. (I didn't see her personally, and don't know whether this was occurring only in the previously stimulated quadrants, or in some degree in the under developed quadrants.) When her baby was born, again by NCB, the nipple pain again occurred. They went for CST directly after hospital discharge, and she continued nursing that baby without pain or supplementation or other problems till her daughter self weaned well into her 3rd year.


I tell this tale for two, or possibly three reasons: 


        1) Obviously, focusing on one type of a problem with a brassiere left in place can hide the potential for       
            some totally different kind(s) of problems in other parts of the breast(s). 


        2) Self-esteem is an individual matter, and perhaps explaining in a simple way the possible genetic, intrauterine 
            origin of ISG, and assurance that it is in no way the mothers "fault", may help the mother to accept this change 
            in her plans without quite so much regret. Plus, it then becomes extra important to explain the things I have 
            discussed above to help her achieve a better outcome, and realize that as weaning occurs, milk making 
            cells can sort of be compared to leaves falling from the branches in autumn, leaving an important "history" to 
            "guide" the growth of new leaves appearing in the "springtime" of a subsequent pregnancy, as new milk-
            making cells grow and develop on the same "old" branches, stimulated each pregnancy, by each new placenta.

         3) Re-instituting the practice of (knowledgeable) prenatal breast examinations in the third trimester, with 
             prenatal referral to an LC for teaching and prenatal planning purposes has the potential to help some mothers 
             who might otherwise have a very "rude awakening" trying to fulfill their breastfeeding hopes and dreams 
             which have been "fed and watered" by all our private, public and professional breastfeeding encouragement 
             efforts. 
             

K. Jean Cotterman RNC-E, IBCLC
WIC Volunteer LC       Dayton OH

             ***********************************************

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