I have a client whose baby is one week old. When I first saw her, the baby
was on day 3 and had not to that point achieved a deep latch. Actually, I
doubt if he had ever been awake at all. The birth was quick for a first baby
(under 6 hours, but an hour of pushing). Still managed to fit in an epidural
during those few hours. The baby was not offered to nurse until over an hour
and was very sleepy. In hospital, his latch was very shallow and lasted for a
few sucks or even a few minutes before falling asleep. According to the mom,
a very nervous nurse pushed mom to use AIM on day 2 (only 6 oz of wt loss)
and she went home finger feeding. Mom was only able to pump about 2cc of
colostrum on day 3. Baby was peeing and had bm's that day. Oh, yes, he was
circed while not feeding well, as usual around here.
    I worked w/ parents to teach correct latch and baby did achieve a deep
latch for a couple of minutes--long enough for mom to get the idea. I taught
her breast compression and we implemented a consistent pumping schedule w/ a
hospital-grade electric double pump. I also taught her to supplement at the
breast instead of the finger when baby was awake enough. The baby appeared
mildly jaundiced--ABO incompatability. The next morning, she was up to 15cc
and it seemed she was on her way.
    The next day, the most mom could still pump was about 20cc. She was also
taking an herbal tincture to increase supply. This is the thing. She has
breast implants, which were placed near the chest wall and there was no
cutting at all near the nipples. She specifically asked the surgeon about bf
and was told there would be no problem. I told her to space out her pumping
as she was getting exhausted. I told her about domperidone, but she was not
interested. The ped saw the baby, who felt he was doing very well, but
commented on how remarkably sluggish he was.
    Mom took the baby to a Network Chiropractor and dad remarked a few hours
lated at how alert he was that evening for the first time. Unfortunately mom
had a bad experience herself w/ a chiropractor and won't go again. I
suggested she take the baby to her friend who is a massage therapist.
    This is the question I am getting to. Dad described mom's breasts
pre-surgery as cone-shaped, like little pyramids. I suspect this mom has
tubular breasts, but it is really hard to tell due to the implants. Her
areolas are somewhat swollen, but on day 3, I thought this might be from the
epidural. Does anyone have any experience w/ this or any suggestions. (Mom
gave permission, BTW, for this post).
    She is very committed to bf, and is plugging away. She did pump just over
25cc yesterday, so she is inching (millimetering)  up. She is continuing
pumping, herbs and using the tube at the breast w/ compression. She is
waiting for him to wake up, to see if he will suckle more effectively. She is
supplementing w/ AIM as needed, tryimg to use as little as possible. She was
going to try to add goat's rue to her herbs today.
    Any ideas would be greatly appreciated.
Jennifer Tow, IBCLC, CT, USA

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