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. [log in to unmask] Warm regards, Pat Lindsey, IBCLC - Lactation Services www.patlc.com *********************************************** 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(R) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html