I'm currently No Mail, so please send a copy to me, if you reply to this
e-mail. I think it would probably be good for everyone to see any
responses as well. I saw a mom today who has oversupply only on her right
breast. It often chokes the baby (who is a little over a month old) and
she sputters or comes off the breast. It also tends to shoot across the
room and she leaks a lot. In the last week she has developed a sore
nipple/breast on that side only. I think the baby may be clamping down or
doing something to cope with the flow better. She fed the baby first on
the opposite breast while we talked. She was not using what we would call
optimum positioning, but it didn't hurt. "If it isn't broke, don't fix
it." I had her use cross cradle and nose to nipple positioning to achieve
asymmetrical latch on the right breast. She also used a pillow, which she
had done previously, but not for awhile. She did not grimace at all and
said it was much more comfortable. She was able to tolerate the rest of
the feeding without any problems. There was no redness or abrasion of the
nipple or areola before or after the feeding. When I palpated the right
breast, before the feeding, she said the nipple, areola, and to a much
lesser extent the portion of the breast at about 12 o'clock were sore.
I told the mom I would ask you all for advice. I told her that with
oversupply, we often recommend mom's try to nurse from one breast for 3 or
6 or more hours at a time. However, I mentioned that advice was for
bilateral oversupply and also wouldn't apply in a situation with sore
nipples. I did tell her she didn't have to nurse off that breast at each
feeding unless she was uncomfortably full, and also that she could nurse
mostly on the left breast to help the supply even out and help the right
nipple to heal. I really focused mainly on working on latch and
positioning and making sure it was perfect. She seemed to want other ideas
and I gave her a care plan for sore nipples and one for plugged ducts (she
had one a week ago) so that she would have other things to try. She
sometimes had expresses bottles for her husband to feed or to use in public
till she gets more comfortable nursing in public,, sod I did suggest she
could pump to comfort at a particular feeding if she wanted to let things
heal. I will call her again tomorrow, and then will be out of the country
and won't see her or talk to her again till Monday.
Everything else is great--baby led feedings, cluster nursing when baby
desires, lots of feedings and pees and poops. I enjoyed working with this
mom and look forward to your collective wisdom for more ideas. We talked
about lots of other things (e.g. using a sling to help her be more
comfortable nursing in public), but since I'm an hour and a half late going
home, I think this is long enough.
Thanks in advance.
Sharon Jimenez, MS, RN
Breastfeeding Specialist
Apache Diabetes Wellness Center
White Mountain Apache Tribe
Whiteriver, Arizona
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