Hello. I saw a mother today, baby 72 hrs approx, back in for feeding difficulty. I expected to see a hungry baby, unable to latch effectively on inverted nipples. I saw a hungry baby who could latch and draw out nipples, but very painful for mother. Baby needed to be fed (> 10% weight loss) so we started with a pump (Ameda Elite) on one side and a nipple shield on the other. the nipple shield was a great relief for the mother, no pain, baby stayed alert and actively suckled for 15 plus minutes, drew milk into the shield. I was suprised we could only pump scant amounts on other breast, mother had what appeared to be full breasts, although not distended, still with some elasticity. Switched sides, same thing, about 1 cc. Okay, its early in the game and her milk is just coming in now, I thought. 20-30 min later she told me her breasts feel like rocks, full, distended. so I used massage, warm wet compresses and the pump again. Again, same thing, scant amounts 1-2 ccs. Baby back to breast, stays active and alert with shield, but I dont hear a lot of swallowing....comes off after 10 minutes, hungry. Now I am thinking this is milk stasis caused by fluid,swelling,pressure on the ducts, and I am thinking cold compresses, lying supine, however mother is exhausted now and it is time to go home. I advised her to treat the swelling and if the milk volumes pumped don't increase over the next few hours but she remains uncomfortable to call me. she is coming in again tomorrow for a weight check. So my question is, what would you have done, RPS? When would you have initiated it? When do you say we have done enough for now, go home and rest and lets see what happens? thank you for you help. Nothing like trial by fire- Kristen Panzer, MS IBCLC _________________________________________________________________ Don't just search. Find. Check out the new MSN Search! http://search.msn.click-url.com/go/onm00200636ave/direct/01/ *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(R) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html