Question:
Message: Hi, I have enjoyed hearing both of you talk at conferences through the years, and feel I’ve learned so much from you both. I have a mom and baby I am working with that has me puzzled. Baby was only 5-11 at delivery, 37.5 weeks, and was on bottles for the first two weeks while mom pumped. Great milk supply. He does not have a tongue tie, but has issues extending his tongue. We tried a nipple shield, and without, he’ll do fine occasionally and then resort to biting again. Mom has discovered that she can get him on in the semi-reclining (nurturing?) position, but then he bites with the upper gum. He has a high palate, could this be the cause of him biting with the upper gum? The only thing I could think of. She does have ‘smallish’ nipples, which gives him less to get his tongue under. She is very determined and I want to help her succeed. Any suggestions??
Suzy Adams, RN, BSN, IBCLC
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Case Studies
Breast Pumping After Breast Augmentation Surgery
Question:
I am a IBCLC at Stanford and my co-worker asked me a question that I could not answer for sure. She asked: Can a mom who had breast augmentation with incisions under the areola or under the breast pump as a mom would without a history of augmentation? I have had many new moms with such histories pump without a problem, meaning no apparent damage, and most were able to get colostrum. Some moved on to pump transitional milk. I think her question was more in regards to risk of breast damage with pumping? What are your thoughts on this?
Barbara Dodson, IBCLC
Mom with Engorged Extra Breast Tissue
Question
I saw a postpartum woman today with her 5 day-old baby. At about 16-20 weeks into her pregnancy the woman noticed a large lump in her left axilla. Her OB/GYN doctor recommended a biopsy—results showed benign breast tissue. The area continued to grow with the pregnancy and today is roughly the size of a golfball. Milk leaks from the site of entry of the biopsy (which was done in November 2009). No supernumerary nipple is evident. She has a similar but smaller tissue lump in her right axilla. She is incredibly frustrated with the leaking in her armpit. She asked about weaning and wants to take a pill to speed up the process. She said she was committed to breastfeeding until the leaking from the axilla occurred. Can she shut production down in that area only? What do you recommend?
Heather Henry, BSN, RN, IBCLC
A Case of Low Milk Production in a Mother with a History of Breast Augmentation, Stroke, and a Clotting Disorder
Question
I have a client who had breast augmentation in 2001 with incisions under her arms. She said her breasts were a B-cup size and she was “not in proportion” as the reason for the cosmetic surgery. During a medical history, she reported she had previous “mini strokes” at age 21 while on hormonal birth control. Genetic testing revealed a clotting disorder and several mutant genes. Lovenox was prescribed for the clotting disorder.
The mother stated the reason for the consultation as “low milk supply – cannot pump much milk.” Her baby was 2 oz. below birth weight at 15 days of age. A weight check after breastfeeding from both breasts indicated an intake of approximately 2 oz (58 cc). Pumping after breastfeeding yielded another 1 oz (28 cc). The mother has added pumping with the hospital-grade pump but still does not have a full milk supply. The baby is gaining weight and is more content now with supplementation of expressed breast milk and formula.
Do you think the clotting disorder could be related to her low milk production?
Deborah Ehrhardt, BA, IBCLC
Skin flaking from the nipple into pumped milk
Question
We have an African American mother pumping for her preterm baby. The nursery nurse noticed black flecks in the milk. The nursery nurse was concerned so she did not give the mother’s milk to infant. I thought maybe it was her skin flaking off while pumping. I suggested the mother use a larger breast flange while pumping. What are you thoughts on this?