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From:
Autumn Wake <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Wed, 11 Jan 2017 11:38:48 -0500
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Hello,  I Am in need of some help and guidance regarding one of my clients that I have been Working with for several months now. Baby is now 4.5 months old.  G1p1, homebirth momma with no sig medical problems and none during pregnancy. Only significant historical mention is that mom has had Dx of "lumpy breast" in which ultrasounds and diagnostic procedures revealed insignificant prior to pregnancy. She also had a history of high estrogen levels, which were resolved well before baby was born (she said because of birth control x 10 years).  Baby has insignificant medical history since birth, always excellent weight gain and happy baby.  

Saw them initially and mom had significant bilateral nipple pain on DOL1-2.  Baby had a somewhat normal exam and only thing I noticed on initial visit was the tongue didn't extend well past gum line.  We started a nipple shield and body work went on for 10 weeks.  I saw twice during that time and worked on basics, but she always seemed to have excessive nipple pain with no outward signs of damage.  I encouraged her to use the nipple shield as baby was gaining well over normal, and still has been gaining well. 

She kind of fell offfor a while (with the exception of a text or two about a bleb and plugged ducts which she started lecithilin).  She contacted me again at 3.5 months post partum with c/o one persistently "bad" left breast with oversupply issues: plugged ducts constantly, Vasospasms and burning in the nipple, blebs... saw them and it seemed consistent with ptt (baby was still nursing a lot for like 30min at a time, issues with a bottle pushing it out and persistent nipple pain bilaterally although L >R, right pain has since resolved).  Still having nipple pain and then she tells me about these plugs all the time and she has to wake up to pump or she immediately gets them in this bad left breast.  At that time she wakes and pumps ten ounces from one boob at night ( the left "bad" breast).  I went to reassess and had a difficult time assessing tie, thought the lip was a little tight (I am a newly certified ibclc- not confident in my shoes r/t ankyloglossia) and I could not get a good oral functional assessment of a baby that age. I referred to our preferred provider for laser revision, for assessment.  She said no tie.  Wish I would've went to that appointment, why is baby nursing so long at 3.5months and nipples were both hurting at that point?!  I haven't had a chance to communicate with provider since and has been out (and I got busy and forgot).  She got a large plug that was unresolved at 5 days and She went to a breast specialist because she has had a diagnosis of fibrocystic breasts and had insignificant ultrasounds in her past, I thought maybe that could be?.  The horrible breast surgeon told her to stop breastfeeding and that nothing was wrong with breast tissue- probably something with the ducts that pore out of the nipple.

  Why is this one breast so problematic? I haven't seen them again because I don't know what else to do, but i have been trying to set up with a more experienced IBCLC, BUT CONFLICTS IN SCHEDULING HAVE PREVENTED..  I've suggested cabbage on the LEFT BREAST multiple times and I think she is being more consistent now.  Baby now nurses for like 15min.  Mom has put arnica on the plugs and she says that it helps it to go away.  

What am I missing? We have horrible support and not a lot of experts in our area.  Right breast has never had a plug or bleb.  

Thank you, 
Autumn Wake, RN, BSN, IBCLC

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