I have the mother's permission to post.  I was contacted by a mother who is 
pregnant with a 26 week baby and her membranes have been ruptured since 19 
weeks.  There has been some amnotic fluid around the baby's face on noted on 
ultasound, but there is great concern that the baby's lungs may be 
underdeveloped.  Mom wants to do anything she can to help the baby survive 
and would like to provide breastmilk for the baby.  Mom has eczema of the 
nipples.  She has two older that she tried to breastfeed and stopped because 
of bleeding and pain.

I have never worked with a woman with eczema of the nipples.  Since the baby 
will probably be born preterm there will be pumping involved.  We use the 
Symphony breastpump at our hospital, but I am afraid that even that may be 
too much for her skin.  She has not been using any meds for her eczema, but 
the dermatologist just visited so she may be starting on some.

I have 3 different ideas.  (1)Try the Symphony using vegetable oil as a 
lubricant.  (2) I have had one mother use the Whittlestone Breast Expresser 
and she developed a full milk supply for a preterm baby.  Mom is interested 
in this option.  She has never done any pumping and has nothing to compare 
it to.  (3)  Hand expression.  I have never had anyone develop a full milk 
supply by hand expression.

I would really like some suggestions for this mother, so thanks for the help 
(in advance).  Sincerely, Rachel Wahl RN IBCLC

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