I had a very unusual case.  New mom delivered healthy baby at term natural
childbirth.  Baby went to breast immediately.  Mom went home at 24 hours post
partum.  Baby nursed every 2-3 hours around the clock with good deep latch.
At 4 days old, baby admitted to hospital with 12% weight loss and jaundice.
Mom extremely engorged.  We immediately went to work on her engorgement and
kept putting the baby to breast with SNS with formula.  Baby began gaining
and mom's engorgement began to subside but no milk transfer taking place at
the breast!  Mom had no medical condition that would contribute to problems
with milk transfer or production.  No retained placenta.  No implants or
breast reduction.  The mom DID have surgery on her nipples 15 years ago to
make them everted.  They were extremely inverted at the time.  Incision was
"L" shaped on base of areola and went from tip of her nipple down to areola
and across.  This mom nursed with SNS and used Classic pump for 2 weeks and
got milk out.  Only thing I could attribute this to was that somehow the
surgery she had severed the ducts and/or scar tissue formation had formed
around the ducts and not allowed milk to get out.  Mom finally decided to
investigate the San Jose Mother's Milk Bank on my recommendation because she
wanted her newborn to have breastmilk over formula.  Her pediatrician warned
her it was not risk free, with AIDS and all, and that if it was HIS baby he
would give formula.  I sent them both info on the bank and the process and
talked with the pedi.  He asked me if I had told her there were NO risks with
banked milk.  I said to him TWICE that what I said was in the last 25 years
there has been no incidence of infection from any of the banked milk given
out.  I then said "Do you know how many times formula has been recalled in
the last 10 years?"  "Did you discuss with her the risks for formula?"  He
backed down.  Well, my question to all of you knowledgeable LC's is, why
couldn't I get the mom's milk out?  Do you think it was because of the
surgery?  I had mom using warm, moist compresses and manual expression too.
NOT ONE DROP EVER SEEN.  Loni Denman, RN, IBCLC

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