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Date: | Fri, 16 Jan 1998 00:30:24 +0200 |
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Susan - best wishes to your client who wants to breastfeed after reduction
surgery. IMO she is much more likely to suffer engorgement (and worse) if
she makes no attempt to BF than if she does. My care plan would be (1)
initiate exclusive breastfeeding, but have client be prepared to top up with
supplements if baby's urine/stool output shows baby is not "getting enough".
If the ducts are draining at all you would be able to manually express
colostrum at birth, or even now if she wants to "test" this. If colostrum
was visible, then some breastfeeding is possible - it is not possible to say
how much, but whatever it is could be expected to increase. If colostrum is
not present during pregnancy though this would *not* be a reason to
anticipate she couldn't breastfeed. (2) pay meticulous attention to
maximizing breast drainage *from birth*, especially from day 2 - day 10 or
so post-partum - DRAIN those breasts as much as possible (baby, manual
expression, pump). (3) at the first hint of engorgement/pain that will not
resolve with massage and drainage seek medical advice about need for
antibiotic to treat mastitis (I realize this may be controversial!) - if
there are areas of the breast that do not drain because of severed ducts
there will be pain/lumpy areas and potential mastitis lasting several days.
(4) Undrained lobes will gradually involute and give no more trouble, the
remaining lobes will continue to drain and so continue to produce more milk.
The trick here is to treat any mastitis promptly with an antibiotic and
continue to drain the breast as much as possible. (5) Supplements, if
needed, would have to be adjusted as time goes on depending on the baby's
urine/stool output and weight gain. (6) ideally mom would keep in touch with
you on a daily basis until breasts were soft and comfortable and baby was
thriving.
I know others have had lots of success with this, you could look at the
Archives. Good luck to your client.
Pamela Morrison IBCLC, Zimbabwe
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