In a message dated 2.4.03 7:54:48 PM, Diana writes:
> I was consulted at 3 weeks
> postpartum. She was still pumping full time (8-10 ounces per pumping) and
> bottle-feeding; the baby had not consistently latched. In the interim
> until we could get the baby to consistently latch, I suggested she rent a
> Medela Classic.
> After pulling back all the layers of her case, we discovered that there
were two problems
She was distended, which made latching very
difficult.
I worked with her to make certain she
was adequately draining her breasts, using compression techniques, etc,
when she pumped. But after each pumping session, her ducts refilled
quickly and were just as full 20 minutes later.
What a nice job of presenting the facts of this case!
It seems, based on these and the additional facts that you've presented, that
you are right on in your interpretation of the obstacles here. I am
confused about your recommendation to adequately drain the breasts, however.
If when you say *adequately* you mean *as well as possible with a pump* then
this is contributing to the problem of over production.
Was this Mom being *encouraged* to take out 8-10oz per pumping session as
reported above?
In addition while compression will certainly help to open clogged ducts , it
will also,obviously, promote continued over production.
In other words, If you try to *cure* clogged ducts by employing a method that
promotes or prolongs overproduction than you are putting the cart before the
horse and you will never make progress. Along the same lines, why the
recommendation for the Medela classic when she was already pumping enough for
a playgroup with the pump in style?
You mention later in your description that the issue of overproduction has
resolved (totally or somewhat?) but that she is left with severely clogged
ducts. I hope she knows that relieving these ducts will be accomplished much
more effectively with a nursing baby (sucking AND compression) vs. a machine
that only exerts suction. Perhaps she would be willing to try the shield
again? Did you try dripping milk onto the shield while the baby attempted to
latch at all? I find that an obstacle with moving an established bottle fdr
to the shield is often the delay in milk transfer inherent to shield use ie.
they need to suck rhythmically for several minutes before milk begins to flow
and this is quite different from the immediate flow of the bottle nipple.
Dribbling the milk on the nipple to enable latch and around the mouth once
latched maintains interest in the interim.
As is most often the case with issues originating with overproduction,
mismanagement by the breastfeeding help and/or misunderstanding of the
teaching by the mother plays a big role and seems to have in this case as
well as this mother's overproduction was sustained for many weeks post
engorgement.
Lynn Shea Rn,Bsn,Ibclc
Franklin,Massachusetts
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