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Lactation Information and Discussion <[log in to unmask]>
Date:
Fri, 18 Feb 2000 10:51:45 EST
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Dear Friends:
    I had reported a while ago about a 46-year old primagravida referred to
me for support. She and her baby got through the milk surge, up through the
first growth spurt with no problems. Baby gained 1 pound at the first peds
visit. So we parted company.
    She called me 4 days ago, complaints of nipple and breast pain, nipple
looking like a lipstick when it came out of baby's mouth, baby very fussy and
unsettled, baby resisted going to breast even when hungry, explosive poops,
milk dripping all over. And this is on one breast per feed!
    Over the past few days, the baby has settled. Recommendations were for
the mother to pump off the first 1/4 to 1/2 ounce before putting baby to
breast, and keep one breast per two feeds or per two hours, depending on
baby's requests. The baby is calmer now, and the nipple doesn't look like a
lipstick any more. However the mother is having severe breast pain: burning,
sharp, that goes deep in the breast. Baby's mouth is clear and clean. Turns
out she is using a nursing pillow as a shelf. Recommendations made: 1) to sit
up straight in front of a mirror, look at direction nipples point in, and
bring baby to breast in line with that nipple direction; 2) quit the pillow
and use a bed pillow to support her arm; 3) use warm compresses or pump off
1/4 to 1/2 ounce when deep breast pain after feeds to rule out/ treat  duct
cramping as a cause.
    It came out today that this mother has bilateral silicon breast implants,
inserted through the intramammary fold, onto the chest wall below the mammary
glands! Her breasts were small. Isn't it amazing that a 46-year old who got
her baby on the 4th in-vitro attempt, with breast implants could have an
oversupply? I wonder if the pillow and the implants are factors contributing
to the deep breast pain, because they are bending the ducts inside the breast
and may also be bending any scar tissue, hence the recommendations I have
made. We are in touch twice a day, so I can keep you all informed.
    I don't ask about breast surgery when a brand new mother comes for care.
I ask about and assess the birth and lactation history, positioning, and the
baby's behaviors. Information about the baby's mouth at breast comes from
immediate inspection of the nipple the very instant it leaves the baby's
mouth. Because of my craniosacral therapy background, I keep my intention
pure that this mother will breastfeed fine and make lots of milk; I do this
by not asking about factors that might cause a problem. If the mother has
been nursing for a while and comes to me 2, 3, or 6 weeks out, then I would
certainly assess for surgeries and infertility.
    I look forward to hearing loving replies.
Nikki Lee RN, MSN, Mother of 2, IBCLC, CSTP, CIMI
Elkins Park (a suburb of Philadelphia, Pennsylvania,  northeastern USA)

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