Ann,
Are you sure there was no breast surgury in the past
such as breast reduction etc?

In another thought, I recently had a young (17 year
old) mom that had somewhat similar breasts/nipples, no
past surgery and unable to express or pump anything
although her breasts felt moderately engorged.  She
was of African American descent.  We tried reverse
pressure softening on the nipple but still no flow.  I
was unable to express or pump for her also.  Her
mother was able to manually express her through using
a small basin of warm water with daughter's breast
hanging over it and gently massaging and gently
twisting the breast clockwise and counterclockwise
with 2 hands repeatedly.  No nipple pressure.  The
flow was a good stream and the relief this gave her
daughter was noticeable.  And her breast softened
considerably.  We were unable to harvest the milk
however because of soaking and massaging while in the
small basin.  I wonder to this day if maybe she was
"wired" slightly different.  Her nipples were tough
and did exactly the same as your description.  Jean
Cotterman(sp) seems to know the wiring of breasts well
and maybe would have some insight as to the "wiring"
possibilities.

Jean are you out there?

Anecdotely, her baby was also 34 weeks and still in
the hospital.  I dont know if after her manual
expression she was able to then pump or manually
express using any other technique.  We are in Germany
and she was visiting from another base and was going
to where the baby was (1.5 hours away) in the morning
and remain there and followup with their LC.

Theresa Johnson RN BSN IBCLC
Heidelberg Germany


--- Ann Perry <[log in to unmask]> wrote:
> I need help from all you Wise Ones.
>
> I am working with this woman, first baby, 34 weeks
> gestation.  Delivered on
> 2/2 vaginally with epidural then pitocin to augment
> the labor.  Her only
> complication from the delivery is severe
> hemorrhoids.  She is Indian and her
> husband stays with her, assisting her with
> everything.  She appears educated
> and speaks English well.
> The baby is in a level II nursery due to his
> immaturity and still does not
> have a coordinated suck/swallow.  On 2/4 they placed
> a feeding tube to help
> give the baby his feedings.
> The mom had breast changes during pregnancy and when
> I saw her for the first
> time on 2/4 I could palpate milk production.  The
> breast are moderate size
> with very firm areola and nipples.  When I had the
> mom hand express her
> nipples which are slightly everted, they flatten and
> even appear to look
> inverted because the areola tissue comes up and
> around the nipples.
> Here is my dilemma: I had her hand express on both
> nipples and there was NO
> sign of milk.  Then I tried (which I do not like to
> do because of discomfort)
> but I wanted to show her some milk -- nothing.  Not
> even dampness.  I set her
> up with a double electric breast pump and there has
> been no sign of milk in
> the flanges yet.
> I assisted her with the baby and ended up with a
> small nipple shield so the
> baby could latch.  There has been very little
> sustained sucking from the baby
> and no milk transfer.
> Today I saw her and the breast are fuller but no
> milk from her efforts.  She
> has had no surgeries or problems with her breast.
> Her mother breastfeed
> without any difficulties.  She says the hemorrhoids
> are painful but she has a
> stoic face.
> Her nipples almost appear tough like s/p radiation
> therapy to the skin.
> My impression is a problem with letdown or some very
> bizarre nipples.
> Any help would be appreciated.
> Thanks,
> Ann Perry RN, IBCLC
> Boston, MA
>
>
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