I was with a mom at her birth. I saw her breasts before birth. On day
three her breasts were firm, full feeling, and hard. No milk could be
expressed. Baby had damaged nipples so much, at first thought of
scabs, so soaks of saline, and took care of that. Still no milk to
speak of expressed. Less than could be picked up on the BabyWeigh at
day 5. Breasts still feeling full. Baby's suck not so great. High
palate, submucosal tongue restriction, and pain for mother is the
reason she chose to express using a hospital grade pump. No milk
released. Hand expression, I could express small amounts onto a spoon,
but it took quite some time to collect. Hand expressed until some
milk started, pumped. Less than 5cc per breast. Baby was losing too
much weight, and supplementing was necessary. Also using a nipple
shield makes it possible for him to maintain a latch that does not
pull mom's nipple up into the dip in the palate that is very
pronounced. He enjoys nursing, and mom is healing.
The midwife sent mom to breast specialist for ultrasound since mom is
still firm, and breasts are not softening. Mom was told she had very
little milk in the glands, the breasts would never make much milk, and
that the swelling she felt was from prolactin. She was told she could
nurse for bonding but no more than five minutes per breast, as it was
not good for her breasts to nurse when there was not a lot of milk
flow. Nothing could be done to change it and that if anything longer
nursing could make it worse. Also, that she never would make any more
than she is making now and she should know that with any subsequent
babies there would be no difference. I know she may have an impaired
milk supply, but I do wish the doctor had not told her it was
hopeless. She said it nicely, but now it is out there. I have worked
with moms who had zero breast change during pregnancy, no breast
tenderness, and with time and nursing/pumping and some herbs they
begin to make milk, sometimes more than even I expected. I have not
seen the report yet, but will as soon as it is sent to her primary
provider. I would really like someone in our lactation community to
take a look and let me know what they see. Also, is prolactin
responsible for breast swelling? If not, what else could it have been?
(This was a home birth, zero IV fluids, average length labor, baby
latched at birth and there is no mother/baby separation.)
I know about insufficient glandular development. Most moms do not
report ever feeling full, no changes in the breast, etc. And, then
there are the moms who do have the fullness, but they are able to
empty and become soft between feedings. Not sufficient milk but it
does empty. Is it possible to have the development, the breast
changes occur, and then just no milk production for no known reason ?
I want to be able to give her the best chance at maximizing the milk
she has, and a realistic answer. If she is not going to have any more
milk than she is making, she may continue to nurse for comfort once
her nipples finish healing. I would at least like to offer her some
reason why her breasts got so much larger, firmer, and stayed that way
no matter what we did.
Thanks,
Pam MazzellaDiBosco, IBCLC, RLC
Florida
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