Hi Laura, You are off to a good start. I do have a few more questions for you.
You didn't say anything about the appearance of the left breast other than there was nipple trauma. Was there milk in the left breast and was the breast soft or full? Did mom have radiation on that breast? If she did, I don't believe she will have any milk on that side.
Where was the mom's incision? What was the appearance of the nipple trauma?
Did you check to see if the baby was tongue tied? Hope tomorrow goes well for you. Sincerely, Rachel Wahl RN IBCLC
> Date: Sat, 8 Nov 2008 22:15:44 -0500> From: "Laura Miller, RN" <[log in to unmask]>> Subject: complicated case> > Hello everyone,> I had a mom and baby come into my office this morning for a 4 day post=20=> > partum follow up and clearly, the first thing I noticed was that baby was=> very=20> hungry. Mom and Dad had said all was well up until night before and she => has=20> since not been able to latch baby, baby crying and obviously hungry. My=20=> > initial reaction was, well, she's hungry, so lets just start with feeding=> her and=20> then we will cover the newborn exam, etc. and talk whilst nursing...> > She explained that she had not nursed on left breast since discharge due => to=20> pain and nipple trauma. She explained about pmh of breast cancer and=20> lumpectomy on that breast. Her right breast, which she has continued nur=> sing=20> on, she was now unable to latch baby. When I tell you her right breast c=> ould=20> be a picture of teaching for areolar edema, I'm putting it mildly. Not w=> here=20> you want to be on day four with a hungry baby.=20=20> > So, we tried latching, next to impossible. We tried reverse pressure sof=> tening,=20> but the baby was so hungry and upset, she was not having going back and=20=> > forth. I ended up teaching hand expression and expressing into a sterile=> urine=20> cup and cup feeding her infant about 50ml. I am lucky to have a great do=> c=20> who is a good friend and trusted me enough to let me spend the time in=20=> > getting the baby fed without supplementing, seeing as she was down 13%=20=> > since birth. However, mom has milk, so why would we supplement with=20> anything other than EBM.=20=20> > So, I'm seeing her at home tomorrow. She is now a little better on track=> after=20> teaching, however I'm still concerned. She had said that her left breast=> , with=20> the surgery and cancer had radiating pain initially postpartum. I'm thin=> king=20> this is because the baby was latched wrong, but is there anything I shoul=> d be=20> concerned with otherwise? I've got her first hand expressing or pumping => as=20> needed to feed the baby if she is unable to latch and doing either cabbag=> e or=20> cold compresses between. Can I be recommending anything else?> > Thank you to any of you who made it to the end of this LONG note!> > Laura Miller, RN> Connecticut> > ***********************************************> > Archives: http://community.lsoft.com/archives/LACTNET.html> To reach list owners: [log in to unmask]> Mail all list management commands to: [log in to unmask]> COMMANDS:> 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail> 2. To start it again: set lactnet mail> 3. To unsubscribe: unsubscribe lactnet> 4. To get a comprehensive list of rules and directions: get lactnet welcome> > ------------------------------> > End of LACTNET Digest - 8 Nov 2008 (#2008-62)> *********************************************
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