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 *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html To reach list owners: [log in to unmask] Mail all list management commands to: [log in to unmask] COMMANDS: 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail 2. To start it again: set lactnet mail 3. To unsubscribe: unsubscribe lactnet 4. To get a comprehensive list of rules and directions: get lactnet welcome