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Subject:
From:
Dawn Burke <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Wed, 12 Dec 2007 22:30:21 -0500
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I'm posting to two locations; please pardon if you get this twice.
I have the mom's permission to post.
I received a call today from a mom with a newborn.  Baby born Dec 8 at 7 lb
1 oz, 41 weeks. Weight on Dec 10 was 6 lb 9 oz.
Mom was induced.  She has anticardiolipin antibodies (has had three
miscarriages) and has been on heparin for the past nine months-- still
taking it.  (I've worked with this lady's sister, who has rheumatoid
arthritis).  She had not gone into labor at 41 weeks, so was induced "from 0
centimeters".  Baby born vaginally but with lots of tearing, mom
had epidural.  Baby stayed a couple of days in hospital due to high
bilirubin counts.  Received some supplementation since baby had two wet
diapers in 3 days with mom nursing very frequently.

Mom says her right breast feels "locked up".  Baby is nursing just fine from
left breast, but doesn't seem completely satisfied after feedings. Mom
thinks baby may still be losing weight, or at least not gaining. She has
started a small amount of supplementation (formula) but is aware that she
needs to pump as well.  She is following up with HCP for bili levels, so
baby is being seen regularly for now.  Since being home, mom has been
nursing every 2-3 hours.  I discussed lots of skin-to-skin to encourage baby
to nurse more frequently and build up milk supply in left breast.  Mom likes
to nurse lying down since she has too many stitches to make sitting very
comfortable.  Her right breast is getting quite engorged, but she is unable
to express more than a few drops with a Medela Advanced PIS or by hand.  She
did get fitted for larger pump flanges, which she says are more comfortable
but she still can't pump more from the right breast.  Baby will not stay on
right breast and gets very frustrated.  Mom has no past injury or surgery to
the breast.  She has tried hot compresses, breast massage while in a warm
shower.  Nothing seems to get the milk out.  I encouraged her to keep trying
to pump and do skin-to-skin; if she gets really uncomfortable, to try
cabbage leaves as well.

I asked if baby has been checked for tongue-tie and she thinks not.  She
says the baby will sometimes clamp on her nipple very hard.  HCP says this
could be from baby's high bilirubin (?) and the baby may have a "tense jaw".


Any suggestions?  I'm thinking a plugged duct would be more localized and
she'd be able to express some milk. Could the anticardiolipin contribute to
this, even while she's on heparin?  It sounds to me like baby isn't latching
effectively (I did discuss letting baby self-latch with sts, and also
discussed helping the baby to an asymmetric latch).  Baby could be clamping
due to tongue-tie or not feeling well-supported during feeding or....?
Mostly I'm just really puzzled about the one-sided engorgement-- what might
cause it and what to do about it.  Any info is greatly appreciated.

Dawn Burke
LLLL, Georgia

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