Saw a first time mom today with 15d old.  Left breast is severely engorged.  Right breast has an inverted nipple with an accessory nipple just above it (within the confines of the areola).  Mom was almost exclusively nursing on the L, as baby had difficulty latching to R, even with a shield.

Mom called earlier this week complaining of soreness in the L nipple, coupled with the discomfort of the engorgement.  My co-worker did a home visit and started her pumping and bottling to give the nipple some relief.  I saw mom today for f/u.  Baby gaining well (had Ped visit today).

My engorgement theory says to have her feed more frequently; my oversupply theory says to have her space out the feeds.  I've never dealt with too much milk in one breast and not enough in the other so I'm at a bit of a loss here.  Mom's goal is to return to exclusively feeding at the breast.  Dad is supportive.

Current plan is to offer L breast(sore nipple) for all feeds, limiting baby to 5-10 minutes and then letting him go to R breast (inverted) to finish and linger.  May need to pump L side just for comfort.  Will need to pump R side 8-10x/24hrs.  Limit bottle feeds to 75mls so baby will be hungry more frequently to go to breast.

Showed mom Australian hold and she loved it.  Also tweaked the latch a bit, although it wasn't bad to begin with.  Any suggestions of how to manage this at two weeks out?  Is this engorgement or oversupply?  How to decrease on the L while trying to increase on the R?  She is using cabbage, and we have talked about sage and peppermint as well.

Sorry if I left out any important details but this is getting a bit long.  Thanks for any thoughts.

Anne Duret, RN 
 
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