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Subject:
From:
Ann Perry <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Fri, 27 Dec 2002 17:31:31 EST
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HI Everyone,
I need to ask a question to the masses and vent a little.
A mother, 2 weeks postpartum came to a breastfeeding support group today with
some horrible looking nipples.  She had left the hospital with cracks but
nursing, using hydrogel, then got engorged, so baby refused to latch, pumped
3 days (Isis pump then PNS) and after a week got baby back onto breast with a
regular shield.
Today is the first time I have seen her.  Both nipples have large cracks,
crest shape, deep along the nipple areola juncture, on the outer aspect of
the nipples.  The aureolas are red and inflamed.  Mom is afebrile and has had
no symptoms of a fever.  She describes the initial latch painful but then the
rest of the nursing is pain free.
She had been using purified lanolin after all nursings and a nipple shield.
I adjusted the position and then recommended APNO.  I called her OB's office
and then faxed Dr. Newman's information to her.  The OB called me back and
was irate that I was making a diagnosis and prescribing medicine.  I told her
I was making an observation and a recommendation.  The OB is mad at me and
feels she has no other choice than to prescribe this cream and she is
demanding to know our protocol on seeing patients.
Now, I have done this in the past with other doctors and have had no
problems.  I am looking to this group of those who cannot write prescriptions
but know your clinical knowledge and expertise what is the problem and how
best to resolve it.
I guess I am looking at how to approach this in the future, but I also would
like some credit that I know what I am seeing and talking about.
Ann Perry, RN IBCLC  (having a bad day)
Boston, MA

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