I do not have any special expertise except anecdotal for several mothers over the years. But here are my thoughts. <but has extreme pain >>when feeding (the midwife who called me couldn't tell me if the pain >>continued between feeds)> <Apparently this >>woman has asked the midwife to "give the baby a bottle" for the next feed >as >>it is just too painful, so I need information ASAP. Sorry I can't give >more >>information at this stage as everything I've been told has been 2nd hand.> One thing I would consider important is more precision in describing whether the pain being experienced is in the nipple-areolar complex and/or in the breast itself? It would be important not only to examine the breast first hand but to observe a feeding, to provide objectivity. Anxiety may be making the mother unable to be very objective about the source of the pain, as she is the person who underwent the surgery and has had months to worry about it. She may have been anticipating it would hurt more than her first experience, setting up the possibility of a self-fulfilling prophecy in her mind. Is this baby bigger and a more vigorous nurser than the first? Let's be sure all the usual latch factors (tongue tie/action, eccentric grasp, babe tucked in firmly etc.) have been checked out thoroughly first rather than automatically assuming that the surgery is the culprit. Where is the incisional scar in relation to the edge of the areola and the breast tissue, and compared with the location of the pain? How long before the pregnancy was the surgery done? It sounds as if that amount of time + 9 months would have allowed internal and external incisions to be well healed. However, even relatively new scar tissue may be somewhat painful when stretched severely. She is, after all, 4 days postpartum. Let's hope that factors like multiple IV's, IV pitocin induction, and/or epidurals that are so common in the US are not causing extra severe and prolonged engorgement. And as you mentioned, at what point in the feeding is the pain experienced? And for how long? Observation of a feed should help correlate whether pain is coinciding with MER. Can using a pain scale help to identify if the level of pain reduces considerably within a few minutes after latching as it often does if the milk sinuses were overdistended to begin with? If so, gentle digital extraction to soften the areola before latching often reduces latch pain, in addition to reducing tissue resistance to the baby's efforts. As for the breast itself and any interrupted ducts/painful MER, ice packs for 20 minutes 3-4 times a day to reduce the circulation to the alveoli whose ducts were blocked worked just fine for the 2 mothers I am remembering, many years ago, before cabbage compresses became common knowledge. I do not think her situation re: engorgement would be any more painful that severe engorgement in a mother without a breast reduction. I think nature will take care of involution of blocked alveolar tissue in short order by the same means that allows some mothers to wean "cold turkey". (That phrase has nothing to do with my preoccupation with readying our Thanksgiving feast-it's simply our slang for sudden cessation of any activity.) I hope these thoughts provide "Food for Thought" because "Breastfeeding Matters"! (Hi, Maureen) K. Jean Cotterman RNC, IBCLC Dayton, OH USA ___________________________________________________________________ Get the Internet just the way you want it. Free software, free e-mail, and free Internet access for a month! Try Juno Web: http://dl.www.juno.com/dynoget/tagj. *********************************************** 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