I have permission to post client's situation. I spoke with a client at 38 weeks gest. She was unable to nurse first child (3 yrs ago) because of severe weight loss in baby despite "constant nursing." I asked her some questions and suspected tubular breasts. Today baby girl is 4 days old. Approx 40 weeks gest (although OB claimed baby was "due" 10 days before actual birth, mother has long cycles and she says baby was 40 weeks.) Born at 6 lb, 15 oz. lowest wgt. in hosp 6 lbs. 3 oz. Weight today before feeding (per Medela Baby Weigh) 6 lbs. 2 oz. After feeding, 6 lbs. 2 oz. Mother's breasts are pendulous, one noticably smaller than other. Deeply pigmented large areolas (light skinned caucasian), large nipples. Mother says they have "plumped up" in the past two days, "Rounder than ever before." Mother developed breasts very late, did not start puberty and any breast development until age 16.Said breasts had little growth during either pregnancy, but a little more growth with this preg than the first. On palpation, breasts very soft, I found one spot about the size of a small flat plum on each breast, about a hand's width back from nipple. During feeding, baby started swallowing when massage was applied to these areas. Baby had four wet diapers last 24 hours and one medium, darkish stool, baby's bili count was 10 on discharge. Mom saved last diaper for me and the urine was concentrated and dark yellow, no odor. Advised mom to place tissue in diaper to check for wetness and color. Ped will do an other Bili count today. Baby's skin looked a bit wrinkled (and orange,) yet supple and moist. No tenting on hand and good moist mucous membranes. Mother said baby was "born wrinkled." Baby happy to suck, doesn't seem to care if she gets milk or not. Open eyes when swallowing, but falls asleep after a few minutes and I had to coerce mom to wake her up. Had to correct both lip placement (curled inward) and remove baby and reposition when baby jerked head back to place nipple in front of mouth. More than 60 seconds of sucking before any swallowing could be heard. Mom does not feel MER. After initial pain first 2 days mom says nipples have little feeling. Baby swallowed for 60 to 120 seconds on each breast then reverted to non-nurtritive sucking. Mother did not realize milk transfer had stopped. We massaged and switched sides and got a few more seconds of swallowing, about 30 seconds, then 10 sucks per each swallow, then clicking began. I removed baby and mother said she had assumed the clicking was a sucking pattern. No detectable weight gain during 15 minute feeding. Most of feeding was teaching mom to recognise what the baby was doing and how to determine nutritive sucking and maximise it. Gave mom direction for old fashioned super switch nursing! Needs to keep baby awake and swallowing. On suck assesment baby refused offered finger at first (and gave me a really cute look,) when she did take it (I try to be gentle and will give up before I will force a baby) I noticed proper troughing of tongue, good suck, but smaller than average oral cavity. The hard palate seemed low. Mother became tearful as we discussed possible causes and treatments. She had the same problem with her first child and said she "had to stop breastfeeding because the baby wouldn't take the bottle while she was still nursing. It was so sad. I can't go through that again. She was starving." From the baby's weight pattern it appears she may have been. She had discussed an SNS with her ped and the ped laughed at her. (!!!!) She is willing to use SNS or cup, but thinks maybe the new ped may not suggest supps. (I am all but certain he will.) Introduced SNS and will start her on one after ped appt. I have read conflicting reports on the success of galactogogues with insufficient ductal tissue. Her OB didn't even notice obviously anomolous breasts in two pregnancies, getting him to prescribe anything will be nearly impossible. Does anyone think fenugreek might be worth a try? I detected only one mass of ductal tissue in each breast, with the rest of the breast very soft. That doesn't mean the ducts aren't there, just that I couldn't feel them. Low supply, appearance of breasts and lack of weight and hx with first child seem to indicate ductal problems. We will be standing by with a pump and SNS for her return from her ped's appt this afternoon. Should I load her with Fenugreek too, or will she be overwelmed and not helped enough to bother? I am thinking that if we can get those few ducts she has to make the most milk possible, the better they will be. Am I right? Help. Mary Jozwiak IBCLC Private Practice *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html