One of my fellow LCs is seeing a mom, and asked me to post to the list, so
here is what I know:

Mother came in for a consult because of weight loss in baby, and firm,
engorged breasts around day 4.  Nipples were not sore...latch appeared good,
but baby only able to get a few cc's despite vigorous suckling.  Lactina
only obtained drops initially.  Mom went home with her pump, did warm
compresses...only able to get 1/2 oz from each breast maximum.  Seen the
next day...breasts felt "lumpy", like milk was there, but couldn't get out.
We sent her home with a Whittlestone breast expressor to try, thinking the
different mechanism of action might help, but no better. Oxytocin nasal
spray was prescribed the same day, but she tried it before one pumping, and
got nothing...not even drops.  The next pumping was back to 1/2 ounce,
without the oxytocin.  Breasts still feeling full, per mom, and do not
soften completely after pumping.

Past history is significant for thyroid cancer treated by surgical removal
only.  She takes synthroid, but has not had levels done since before the
pregnancy...so she is having those done.  But I wouldn't expect this picture
with hypothyroidism...I would expect flaccid, "empty" breasts.  No vaginal
bleeding.  Had a precipitous vaginal delivery, so oxytocin must have worked
on the uterus.

Any ideas???

Kathy Leeper, MD, IBCLC
Medical Director
MilkWorks, a nonprofit breastfeeding center providing consultations,
education, support and related supplies in Lincoln, NE

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