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A 30 year old G2P2 now. Now Day 4 postnatal. Baby born vaginally at 38 weeks gestation and 6lb 5oz. BF first baby (who is now age 4) x2 years mainly on left side due to latch problems on right. On No meds other than prenatal vitamins. Last night engorgement began on right side only. All usual care done with no relief.  States continued difficulty with latch on right side and has graze on nipple as well from first 1.5 day of breastfeeding. Visited client on day 2 and after education and assistance the Latch was painfree and looked appropriate, with signs of swallowing. No problems with left side latch at all.  Grandma noted mother had slight swelling of feet after delivery. No IV fluids during labour or delivery. Baby jaundice due to bruising secondary to precipitous delivery. I have encouraged RPS today as well as application of cool compresses and brief application of cabbage to affected breast only, as well as Moist wound care of damaged nipple. Encouraged to hand express to comfort and feed with careful attention to latch on affected side.  She has tried a pump but with minimal relief.  I am visiting this evening to reassess. Am thinking may need to work on alternate positioning and reassess for swelling. Is there anything else I'm possibly missing?
All input greatly appreciated. We have no access to alternative therapies such as cst where I live. 
DeeDee Voisey IBCLC
Goose Bay, Newfoundland & Labrador
Canada

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