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Date: | Fri, 16 Dec 2005 08:31:58 EST |
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I wanted to share with this group something I noticed at work yesterday that
fits right into the discussion of hand expressing and lactiferous sinuses
(LS).
This mother just had her second baby and after only 24 hours post delivery
had developed sore nipples and was requesting to pump.
On exam she has large breast with everted nipples, soft areola and damage to
the tips. Mother describes that the baby has been feeding constantly all
day and "tearing chunks off my nipples."
I asked the mother if she could hand express some milk onto her nipples.
The way she demonstrated this was to take her finger and thumb just behind the
nipple and squeeze. Nothing happened. I had her move her finger and thumb
farther out from the nipple and then compress stopping about 1-2 cm from the
nipple. There was the milk. Now the baby is still rooting so I asked her to
try breastfeeding again. The baby's tongue is slightly short due to a
posterior tight frenulum. The baby starts by just grasping the nipple, when I had
her adjust the latch so the baby came on with more head extension and
allowing an asymmetrical latch, she had no pain. The baby went onto breastfeed with
noted swallowing and then came off satisfied.
The light bulb for me was that this mother assumed that the milk was behind
the nipple and therefore not thinking anything about how the baby was
latching. As I corrected where to compress all this discussion came to clarity. In
my practice, I adjust mother's fingers to basically stop where their LS are
but not really thinking about how far out some moms need to stop to find that
point until now.
I hope I am being clear in what I have observed and I plan to be even more
aware of where I have moms stop to compress based on when the milk is
expressed.
Ann Perry, RN IBCLC
Boston, MA
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