>Mom came to me with a healthy 3 month old, nursing every 3 hours for
>15min/side.  She has been using a nipple shield since birth due to a poor
>latch and tongue tied.  Mom c/o chronic plugged ducts and "borderline
>mastitis".


>For the next 3 days baby continued to latch well, mom felt like latch
>continued to improve each time.  Stool went from green, slimy and stinky to
>normal yellow stool.  On night 3, baby refused to nurse without shield.  The
>next morning mom c/o plugged ducts, hard/ red/hot breast, pain.  I enc her
>to nurse as often as possible, adequate fluids,  massage, bedrest, cabbage,
>ibuprofen.

This sounds like she has a tendency toward oversupply -- the baby's 
stools are consistent with lactose overload, as well the mother's 
"chronic plugged ducts and 'borderline mastits'".  Nursing 15 min per 
side q3h was probably contributing to the problem by not giving the 
baby access to sufficient hindmilk, not to mention he probably never 
really drained either breast.  How has the baby's weight gain and 
growth been so far?

My inclination would be to have her manage the oversupply by Gonneke 
Van Veldhuizen's method of nursing/expressing/pumping both breasts 
until they are as empty as she can get them.  This may be 
uncomfortable and take a lot of patience and massage with all the 
plugged up areas she has right now.  However it should also bring 
some relief right away. When the breasts feel empty, she begins 
"block nursing" -- using only one breast for a block of time lasting 
a few to several hours, then switching to the other breast for the 
next block of time, continuing indefinitely in this way.  With her 
current level of inflammation and plugs, she should probably take it 
slow and start out with relatively short blocks, like 2 hours (ie 4 
hours between turns on the same breast).  As her supply starts to 
come down a bit, she can increase the blocks to 3 or 4 hours or even 
longer.

The textbook description of "nursing every 3 hours for 15 min/side" 
makes me wonder if the baby's feeding cues are being heeded or if the 
mother is following some kind of parenting program. If the mother is 
scheduling feedings that could be contributing to the problem by 
taking away the baby's ability to regulate his mother's milk supply.

Considering that the baby is tongue-tied and hasn't been latching 
well even with a shield, it is fortunate that the mother has an 
abundant supply -- still at 3 months!  Are the parents interested in 
having the tongue tie snipped?  I would hope that a speech 
pathologist would understand the importance of having full tongue 
mobility!  I think if the mother's supply comes down and the baby's 
TT is corrected they will all be a lot happier.

Margaret
LLLL
Longmont, CO

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