Hmmmm, Laura, I would be writing "?Marginal maternal motivation" in 
my notes on this one, and trying to explore whether this mother would 
really like to stop trying.

It looks as if there has been a rejection of every suggestion to 
reduce the pain of either breastfeeding or 
breastmilk-feeding.  Firstly body-work and frenotomy for possible 
tight frenulae, and/or a nipple shield didn't work.  Since 
breastmilk-feeding has been tried to replace breastfeeding direct, 
the difficulties are: inability to pump frequently enough to maintain 
a full supply, leading to partial lactation failure and even on a 
reduced pumping schedule stated pain/dizziness incompatible with  a 
normal pumping experience in spite of painkillers and apparently 
exacerbated by breast massage/compression.  And finally now a stated 
desire to reduce suction on the pump - possibly to the point that it 
will no longer "work" to extract any milk.

Sounds to me like this client is confounding all efforts to make 
breastfeeding or even breastmilk-feeding possible and may be trying 
to "create" her own conditions to make even just pumping physically 
impossible.  Sad but in my experience not unknown.  And there are 
possibly some major underlying non-lactation related "reasons" in 
there somewhere.  Perhaps I'm mistaken and I hope I am.  But 
meanwhile, as the IBCLC you have done a great job.

Pamela Morrison IBCLC
Rustington, England.
-----------------------------------------------------

Date:    Sat, 9 Aug 2014 17:50:15 -0400
From:    Laura Spitzfaden <[log in to unmask]>
Subject: Mammary Constriction Syndrome?

PTP

I am working with an exclusively pumping mom. She is not directly 
breastfeeding due to pain and nipple-compression. Baby is 10 weeks 
old. The baby has possible structural issues due to transverse lie 
resulting in a planned C/S and tight lingual and labial frenulae but 
parents do not want to do body-work or frenotomy.

It seemed that it was possible to have comfortable feeding with a 
nipple-shield but Mom later said it hurt too much to directly 
breastfeed even with a shield.

She does not feel able to pump more than 4-6 times a day due to pain 
when pumping. She gets between 10 and 14oz daily. Immediately PP, she 
reported dizziness and chest pain when pumping. After improving her 
diet, she reports no dizziness but has continued pain which limits 
her ability to pump.

She describes the pain as following:

<Now, I do not feel light-headed as before. But I still feel pain in my
chest, upper back, spine, neck and shoulders. The pain is in the upper
body. I am taking Advil (2x 800mg, a day). It relieves pain only for a
while and comes back as I keep pumping. I am eating better now and also
taking a Multivitamin (Postnatal) daily.

I'm using 30mm sized flanges. I guess they fit me well. My nipples do not
rub against the walls of the flanges and my areola is also not drawn into
the flanges. Only my nipples are completely drawn into the flanges.
However, I think I might be turning the suction high. I would want to try
lowering the suction and see how the pain would feel.>

I have encouraged her to massage before and during pumping to help 
with let-down, but it only seems to increase her pain. Does this 
sound like mammary constriction syndrome? Would simple doorway 
stretches help or would she be better off with body-work herself?

Laura


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