I would question the flange size, and the 15 minutes of pumping. Edema is ALWAYS a possibility when pumping depending on the stretchability of the areola, the structures underlying the areola, the location and length of duct system prior to branching of the ducts. Perhaps mom needs smaller flanges? Hand-expressing midway during a pump session (think how babies pause between let-downs and do tighter sucks and more rapid sucks) or how moms will switch twins to opposite breasts, as a model. Also, different hospital grade pumps have different mechanisms, curves in the suction pressures, etc. They are NOT all exactly alike.
-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Celina Dykstra
Sent: Wednesday, March 28, 2012 7:25 PM
Subject: persistent areolar edema - long post
Permission to Post,
I am working with a client who has had numerous issues with breastfeeding since her firstborn, a daughter, was born on Feb 27 of this year. Baby caused nipple damage with a shallow latch form birth, they have dealt with thrush, jaundice, weight loss, a reaction in mother to feeding at breast after cow's milk supplement (paced bottle fdg first then breast), had to discontinue feeding at breast due to nipple damage recurring and mother has fibromyalgia and has developed Raynaud's as well as possible Mammary Constriction Syndrome. Mother has had difficulty pumping all along. R nipple is worse, L has edema after app. 7-10 min of pumping with little output.
CST treatments have improved baby's latch so she can latch without causing any distortion with every feeding. They are using soy formula which hasn't caused a reaction in Mom, who supplemented successfully at breast with 5 fr. feeding tube after offering supplement in bottle first. Mother is seeing herbalist for support with milk supply and circulation. Baby's thrush has returned, being treated with oral Nystatin and mother has chosen to continue with APNO.
Mother is currently attending a course she couldn't miss but where she is able to pump regularly through the day. Mother was able to rent a hospital grade pump and flanges have been sized for fit by LC. She uses breast compressions while pumping. Grandmother is there with her looking after baby. However, mother is finding that pumping is becoming more difficult with more edema occurring throughout the day. By the 3rd pumping of the day, she reports she is experiencing pain when pumping. She is pumping for app. 15 min per session.
I searched the archives and didn't find anything about edema this late post partum (baby is 4 weeks) I did, however, read of mothers with NICU babies interrupting pumping after 5-7 min to do RPS and then pumping for another few minutes. Another option that mom considered was to pump for less time but more frequently, but this is difficult to coordinate with course content and note taking.
Mother will try interrupting pumping part way through to do RPS and see how that works. along with using gravity with RPS. Mother will try SNS today, as she is having difficulty with 5 Fr. feeding tube on her own and her mother is unable to help her with it effectively. She has also been offered donor milk. Mother still has no pain when baby is at breast.
I look forward to any wisdom you have to share, to help this mom pump effectively and increase her supply.
Celina D, IBCLC, LLLL
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