PTP.  Took care of a prime who delivered twins 2 weeks ago via Csection. Had never put them to breast when in the hospital, was doing skin to skin, and was very successful with pumping.  Had been getting 200ml with every pumping every 3 hours.  Reported that in the last 3-4 days, the Rt breast has suddenly "stopped producing" - is only getting about 1/3 the amount she had been getting.  Had a firm area that she was able to massage out, no other lumps noted.  Now when she pumps that breast, it starts to hurt after she is done - very painful.  Just in the nipple/areola area.  Breast is not getting firm prior to pumping, is not leaking like it had been when in the shower.  She has tried to put the kids to breast, but no latching.  Denies any known injury to breast.  Discussed that it is normal for one breast to produce more than the other one, but this discomfort has me baffled.  Specially with no fullness prior to pumping.  Any suggestions?  She is willing and committed to pumping just the one breast if that is what it takes.  Thank you in advance for help!!!! 

Brenda Enfield RN, IBCLC
Cedar Rapids, IA 

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