I saw a mom and baby on Friday who had been given a nipple shield in the
hospital because of *flat nipples*.  Baby was 4 days old at visit. Mom had lots of
edema (IV-fluids from c-section).  I couldn't latch baby without nipple
shield very hungry baby and not patient at all, but baby did latched to right side
with nipple shield with good transfere.  Left side was very engorged and had
no transfere with nipple shield due to shallow latch confirmed by compression
ridge.  Pumped 4.5 oz from the left breast; baby was sleeping and not hungry.

Care path was given to continue to nurse with the shield till breast were
much softer and pump afterward for 5-10 min to ensure emptying of breast and if
baby seemed hungry after feeding at breast to supplement with pumped milk or
return to breast.

Mom came by today (Monday) for weight check as baby was 6 lbs at birth and
had gone down to 5 lbs 2 oz on Friday.  Baby was up to 5 lbs 11 oz.  Mom
memtioned that she now has large blisters on left nipple and was this normal.  She
said the left nipple always has a ridge across it.  I ask her to put the baby to
breast and immediately saw the white compression ridge form.  On diagital
compression of the areola I found a large (half dollar size) dense mass at base
of nipple.  I manually expressed about an ounce of milk and the mass did not
change in any way.  I have not seen this before.

Mom states that she always gets lots of milk when she pumps the left side
after feeding with the shield, but gets little from the other side.  She also
states that she too had noticed this mass of dense tissue at base of nipple
immediately after the baby was born the first time she put the baby to breast.  So
it was there before engorgement appeared.

Baby cannot get enough tissue in her mouth over the mass and using the nipple
shield is not a good option either.  I have presently suggested feeding on
the right side and pumping the left till we find out more as to what's going on.
Has anyone seen this before?  Is there an intervention to help resolve it or
do you think I need to have the mother seen by her OB.  Please email me
privately as I am not presently subscribed to Lactnet.
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Warm regards,
Pat Lindsey, IBCLC - Lactation Services www.patlc.com

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