Hi again all,
I have been seeing a lady with severe engorgment since day 3 post
normal deliver.  Her breasts are so engorged that the baby is
unable to attatch with or with without a shield.  Softening up the
areola to facilitate a latch involves taking off about 150 mils.  The
baby, now day 6 has only had about 3 breastfeeds a day for the
last 3 days and then only for 5 mins or so and then it coughs,
splutters, the whole works, this is despite posture feeding.
Anyway I decided to manage this Mum the following way and it has
caused a real commotion at the hospital with the midwives saying
that they don't need an LC to tell them what to do!! Read on:
*put the baby to the breast every 1 1/2 - 2 hours for at least 10
mins.
*if the baby refused to feed, express the breasts until they are softer
*if the baby feeds from the breast and the breasts are still not soft
after the feed, express until they become softer.
*In between feeds use cabbage leaves and immediately prior to the
feed have a warm shower or apply a hot flannel to the breast.
Express enough to soften the areola to facilitate latch on.  After
feeds apply chilled cabbage leaves.

The staff strongly disapprove of my suggestion to express if the
baby did not feed.  I feel that I am justified in making that decision.
I feel that if the breasts were left rock hard, the risk of lactation
failure, low supply (ultimately) or permanent damage to the alveoli
is very high.  I feel that if a baby will not feed from an engorged
breast, the breasts should be softened, not drained, just softened
as if the baby were having a good feed.

The staff on the other hand chose to not put the baby to the breast
at all overnight and gave the baby bottles of milk that the mum had
expressed in the day.

I have checked in Counselling the breastfeeding Mother and what I
recommened is suggested in there.  Did I make an error in my
management?
Val in Busselton, Western Australia
RN RM IBCLC