Trish
Welcome out of lurkdom. You described your client's scenario very well. You
are right, there are a few issues. 1) how will her milk production be? 2)how
will her engorgement be? 3)will she have primary lactation failure, i.e. her
breasts are not properly developed for full lactation and that is why she
got the implants?
In any case, I would proceed w/ regular (read optimal) lactation management
but follow her closely at least by phone, or preferrably by return appt and
watch for breast fullness, infant output and wt gain. Treat the engorgement
if it arises, the unemptied breast sections will involute. She may have
enough milk w/o supplements or she may not. If she needs supps then offer
alternate device, preferrably nursing supplementer at breast but this is
mom's choice. I have seen many times where a doctor is not very worried
about these types of things and neither is the mother, but lo and behold the
baby is in real trouble. So bottom line is very close followup and intervene
if needed.
FWIW, I believe in the open-pause-close suck and audible swallow, but I
swear once I saw a baby's first feeding in delivery room and I could swear
he was really getting milk. His jaw was opening so wide and strong and slow.
Later I find out this mom had br. reduction surgery and over the course of
days/weeks working with her she only got tiny amts of milk. Maybe the baby
was really swallowing that frist feeding?

Laurie Wheeler, RN, MN, IBCLC
Violet Louisiana, s.e. USA

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