"(I am a new IBCLC, too, but because there are
other breastfeeding educators in our practice who aren't IBCLCs, I'm not
supposed to identify myself as such, as that would make them look
inferior--don't ask!)."
Whoah! What is *that*?! I know you said "don't ask", Patricia, but it seems
to me that that is highly unethical (on their part, to expect you to not
identify yourself correctly, not yours). Do you know anybody who would, for
example, want to go to a dentists' office where some of the "dentists" were
duly-certified dentists and others were just *saying* they were dentists and
*acting like* dentists, and you didn't know which was which?
"There is a current struggle going on with how much assistance "we" are to
give while they are still inpatients."
Yikes! And wait, there's more...
"Spoke with pediatrician who did not want to
hear about this woman's breast surgery or her lack of breast changes. He
is breastfeeding friendly, but I suspect he may not know (or feel the
need to know) the implications of this information."
I think (not that you asked, and I don't mean to offend!) that you are
working in a very breastfeeding-*hostile* environment! And, as one who's
been there, I commiserate. But it makes me very angry that both the peds
group and the hospital are passing themselves off as being BF-friendly.
Cathy Bargar RN IBCLC Ithaca NY
-----Original Message-----
From: Patricia L Donley [mailto:[log in to unmask]]
Sent: Tuesday, October 26, 1999 4:04 PM
Subject: Augmentation (long)
I am working with a mom who I need help with. As a (mostly) lurker, I'll
first introduce myself. I work for a large pediatric practice as a
breastfeeding educator (I am a new IBCLC, too, but because there are
other breastfeeding educators in our practice who aren't IBCLCs, I'm not
supposed to identify myself as such, as that would make them look
inferior--don't ask!).
Part of my job involves doing hospital rounds, meeting with all new
mothers who are bringing their babies to our practice, assisting them
with initiation of breastfeeding. But not too much. There is a current
struggle going on with how much assistance "we" are to give while they
are still inpatients. The hospital has a few lactation consultants who
get the same amount of pay as everyone else, and get to see breastfeeding
couplets in addition to their (full!) assignments.
Anyway...This mom had subareolar saline implants placed 9 years ago. The
breast surgeon assured her at the time that she would be able to
breastfeed if she so chose. This is curious to me. Her scars are on the
lower edge of her areolae (3 o'clock to 9 o'clock). My thinking is, no
matter how you cut it (pun intended), the sinuses/ducts would have had to
be severed, at least on the lower half of her breasts. Am I missing
something here? Could/would the surgeon do a very superficial incision
and slip the implant between the sinuses and/or behind the muscle and
then fill with saline?
So I'm thinking, worse case scenario, bottom half of breasts produce
milk, but milk has nowhere to go. Would stasis eventually "shut down"
lower half of breast? Could mom still nurse since upper half of breasts
would compensate? Would this constant stimulation be detrimental?
Here's the kicker. As I am talking with mom, I ask her if she had breast
changes in pregnancy. Nope, not a bit! No fullness. No areolar color
changes. Nada. Interestingly, she had a miscarriage at 12 weeks a few
years ago, and she DID have breast changes then. Hmm...
Now I know we have two major issues to deal with here. Are they related?
I would suspect not, since she did have breast changes with her last
pregnancy. I know from my reading that lack of breast changes during
pregnancy can be an indicator of possible supply problems, a "red flag"
of sorts.
I feel like I'm skating on thin ice here. I spoke with the nurses taking
care of this mom yesterday and today. Both thought these issues had
nothing to do with how they would care for her in the hospital. No
lactation consultants on today, of course.
I observed latch today. Mom handles baby well and just seems so in love
with him. Audible swallow, and deep, wide latch. Had never even given the
possibility of implants being an issue with breastfeeding a second
thought. On her prenatal history, she had answered "none" to the question
of surgery. Embarrassed? Didn't consider it a "real" operation?
On top of all this (because of all this?...), baby has lost 10% of
birthweight today, so we're bringing him into office tomorrow for weight
check. Yesterday he was circ'd and slept alot. Today nursed hourly for a
five hour stretch, then relaxed into a deep sleep (this was AFTER that
weight loss was documented--I bet a pre-discharge weight this afternoon
would have shown a gain!). Spoke with pediatrician who did not want to
hear about this woman's breast surgery or her lack of breast changes. He
is breastfeeding friendly, but I suspect he may not know (or feel the
need to know) the implications of this information.
I wondered today about a supplementer at the breast if weight is still
low tomorrow and mom desires this, but am not sure if this baby should
even be at the breast if being there will stimulate production of milk
that can't get out.
Can anyone help me out here? I'm grasping at straws amongst people who do
not think these issues are important, and I wonder if my recent
achievement of IBCLC status has made me read too much into this case.
Thanks for your help!
Trish Donley,RN,ND,IBCLC
Allentown, PA
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