Re Niefert's primary vs secondary IMS:
I was just doing some calculations. Now all of this is from memory, I
don't have the consults in front of me. I have been working for last 15
mos in hosp program. We have 60% bf initiation rate. Now we have about
720 births per year or 900 in last 15 mos; 60% bf rate is 540 bf'ers in
15 mos. I believe we have seen 4 IMS pts. That is 4 out of 540 which is
0.74% (feel free to check my math :)). The histories were:
1. wide spaced tubular breasts - no breast changes, no engorgement -
primary
2. another pt with normal looking breasts but no lactogenesis and we
find out (she tells us) she is sister of the above woman - I did not see
this one personally - primary?
3. Slow gaining baby came to us about 11 wks; hx of PP hemorrhage in
mom, shock, blood transfusions, then put on birth control pill early -
Sheehan's?
4. C section birth, very obese pt, UTI on abx w/ catheter still
currently @ 8 days, still no breast changes. Had C/S due to ? uterus and
bladder in wrong position ? Also, tight frenulum having some impact I
think - mixed etiology?
I am not counting the lady with br. reduction surg, that would be 5 out
of 540 or 0.92%.
All of these were brought in very early (except #3 who came to us from
another hosp), followed with optimal bf management, supplementation at
breast (sns) is offered and #3 and #4 did use this, regular milk
expression with hosp grade double pump, herbs, and often metoclopramide
(mom's choice and if ok with her m.d.).
Laurie Wheeler, RN, MN, IBCLC
SE USA
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