Hi
All help appreciated!!

3 para. all pregnancies spontaneous with no history of infertility or gyne 
problems.
Absent lactogenesis II with 1 st and 2 nd babies despite frequent feeding and 
periods of regular pumping. 
Normal breasts, no visual symptoms of hypoplasia. Normal growth and 
development during puberty and tenderness and increase in size early in all 3 
pregnancies. Even leaking of colostrum in pregnancy.
Normal thyroid function and no other endocrine disease (that we konw of!)

Mum is now 72 hrs postpartum. Normal delivery. Infant lay skin to skin 
undisturbed for 2 hrs after birth and breastfed well. Alert and suckled often 
from birth. Good latch with some adjustments needed and mum has switch fed 
in order to maximise stimulation. 
Infants weight loss, stools and urine were within normal day 2 but due to 
excessive crying and fighting at the breast she was given formula by cup ( 10-
15 ml) with 4 hours interval from about 40 hours postpartum (mums request) 

A major problem is that mum has experienced deep breast pain from the first 
breastfeed. Pain is described as aching and radiates from behind the nipple 
areola complex back towards chest. With suboptimal latch, the pain is worse 
but it is present even with a good latch. mum describes it as "dry 
breastfeeding" and feels that there is something physically wrong with her 
breasts. 

Baby is now 72 hours of age, is feeding frequently and seems to be suckling a 
little longer at each feed (suckling för 10 mins instead of 3-4). Mum is 
cupfeeding 10-30 ml with 3-4 hours interval. She is really trying to limit the 
amount she gives but this is also determined by how painful the feeding is. She 
has small sucking blisters on nipples bilateralt but can connect them to 
nighttime feeding when it has been harder to achieve best latch. No obvious 
signs of Lacto II as yet. No effect of breast compression.
I have reassured mum that it is still early days and that 72 hours postpartum is 
too soon to know what will happen. However, the pattern i s the same as the 
last 2 times and I will not be surprised if there continues to be no signs of Lact 
II.
I have advised her om pain relieving medication (Paracetamol, Ibuprofen) and 
warming of breasts (hot compress) in an attempt to relieve discomfort.

Why so painful and why no milk??!!
Can this be a case of breast hypoplasia?
I have had other mums with recognisable signs of breast hypoplasia who have 
described a similar aching in their breasts during feeding. However this mum 
appears to have completely normal breasts.

Is there a problem with Prolactin?
We are planning on taking prolactin tests in 2 days when mum comes for her 
return visit. I have read the posts on prolactin resistance and wonder if this 
can be playing a part in this story. I have no experience of this and would like 
to know what I should be looking for in test results.

Many thanks for any input.

Zab Franklin IBCLC. Trollhättan Sweden.

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