HELP! (engorged breasts)

fearlessbirth · 08-09-2006, 12:02 AM

Hi! I hope someone out there has some magic for me

I had my postpartum visit tonight with my client who delivered on Friday. Here's the scoop....

When I talked to her yesterday she wanted a referral to someone who could help her with BF. She said the baby would only latch on and feed well on the left side. I gave her 3 #s to local LLL leaders and thought it would be all good. Well, she called me today around 4:30 and said she couldn't get through to any of them, and none of them had yet to return her calls.

She was quite frantic and upset so I hopped online and found some more 3 more leaders north of us...one # was disconnected, another was the wrong # and the other lady couldn't talk until later in the evening after her husband got home.

. I also tried to call the county LC but, of course, got voicemail and figured she wouldn't check it until tomorrow. So I also felt helpless. I called client back and asked exactly what was going on...she said again that her baby was eating well on left side but the right side was so ENGORGED that her nipple was completely flat, her breast is rock hard, full and hot. I offered for her to talk to my good friend (and past client), who has been BF for the past 5 months and dealt with these problems. Long story short, my friend came with me for the visit and tried so hard to help. Yesterday and today, client had tried hot showers, hand expressing, pumping, massaging, cabbage leaves and nursing. Nothing was helping. My friend helped her by massaging, showing expressing techniques she'd used, warm compresses, massaging while pumping, tried getting baby latched on and nothing was helping. She also tried showing her, using her own baby, how the nipple is to fit, etc. Her nipple is also RAW. She tried getting baby on but when he'd get on for a second it was so painful that after about 15 seconds she had to get him off. She can't tell if the pain is from the raw nipple or b/c the latch isn't good.

She is very discouraged and annoyed that she can't find any 'professional' help. She is very worried that the side that is currently 'working' will also become engorged and then she'll really feel at a loss. It's also frustrating to her that every book she reads and person she talks to (stories from family members or other nursing moms) are all different.
Pump/don't pump...never wear a bra/always wear a bra...use heat/cold...try to feed baby/don't try to feed baby...the list goes on. Lol

It is SO important to her that this work. She said she already lost the birth she wanted and they already tried to give her baby formula before they left the hospital. She wants this so bad and I feel awful that I can't help her and I'm running out of resources. My friend and I are going to the LLL meeting in the morning (mom can't go cause she and baby have 2 doc appts tomorrow) so we're going to run it by them and get some advice.

Can you help????

Kim Trower · 08-09-2006, 02:12 AM

hmmm...well baby definitely needs to nurse on that side..if not then pumping or hand expressing but what is in needs to come out to relieve the pain. If she can at least express milk in whatever way that is (even if dad needs to help out) she can tackle getting baby to latch on with less pain.
Baby will not latch on to a rock, so that's the first step.
check the latch, make sure baby is on well and then lanolin to help heal...keeping them dry in between nursings..and her choice whether to wear a bra..some find it irritating others find it more comfortable.
Good luck! It's hard to give advice via the internet when you can't see what's going on.

1stimestar · 08-09-2006, 03:23 AM

Yes, what Kim said. Also some more tips. Ask the LLL LEADER if she can make a home visit. Cold to reduce the swelling of the tissue, heat to increase the flow, so alternate between cold and heat packs every 15 minutes. Also, Ibuprophen to help reduce swelling. The tissues swell so much that the flow is blocked. If she doesn't get this flowing she could dry up on that side or get mastitis. If she does dry up on that side, she can relactate after the damage has healed. She CAN totally support her baby from one breast though she "might" be a bit lopsided for a bit. I would start baby out on the good breast to take the edge of his hunger, then switch to the other breast. Lansinoh on the nipple in between feedings, breastmilk on the nipple after every feeding even if not from that side, and let it air dry. Yes, she does want to wear a bra for support but not one so tight that it blocks the milk ducts. Good luck.

Acacia · 08-09-2006, 08:51 AM

What about a nipple shield for the side that is raw and hurting? Medela sells them fairly cheap. I had really bad engorgement with my first child and I didn't have a pump. I just hand expressed in a hot shower and cried. It was horrible. My daughter also never wanted to nurse on one side and when she did it was only for a few seconds and then she would pop off and that would be the end of it. The baby may not want that side because it is so engorged that a good latch cannot be estabished. In that case pump until the breast is softenened and then try to latch baby on. I figured out that my let down was really strong and my daughter didn't like that the milk was coming out so fast. I helped remedy that by nursing her on the side she liked while hand expressing on the other side. After the milk stopped spraying quickly I would latch her onto the other side. I hope your cient figures this out. I'm sorry LLL hasn't been helpful. Is there not a lactation consultant on call at the hospital?

Acacia · 08-09-2006, 08:54 AM

OH I forgot...heated rice packs helped me a lot also. The moist heat felt really nice and helped me let down quickly. This is probably important for her since she is so raw on the one side. Also...has she tried different positions for the baby? Sometimes babies like to nurse while laying on one side of their body. See if you can help prop the baby up so he/she is laying on the same side while nursing...does that make sense?

fearlessbirth · 08-09-2006, 09:13 AM

Thank you, ladies, SO MUCH!

Acacia~ There is a LC who works at the hospital. I don't think she's 'oncall' b/c she never called my client back. You can see how she's really at her wit's end about it all. I'm going to see about LLL home visits at my meeting this morning. Now that I think of it, this leader does live near my client, so that may be perfect.

And as far as positioning goes, this mama just had a cesarean so the only comfy position is the football hold. I did mention last night about maybe he just prefers one side so if she could football hold him on the left and then just swing him around front, across her body, to nurse on the right. She said she doesn't think she can do that right now with her incision, scar, etc.

My friend did mention dad taking care of this issue for her

but they are worried about bacteria. I even mentioned that my friend's baby (who is a vigorous eater and will take snacks wherever she can get them) could latch on for a few and help out. I think she thought I was really weird at the point...but I was running out of advice/options!!! Lol (Honestly, if my breast looked and felt like that I wouldn't care who or what was giving me relief! Lol)

I also think the fact that right after she pumps her nipple is HUGE is affecting the baby's latch. I'll ask LLL about this today. It's like a lot of the surrounding areola gets sucked into the pump and all swells up like the nipple. It looks really awful. Literally, after pumping, her nipple on that side is the size of a grape (and her other one is like a peanut, I guess...lol I can't think of any other small item.

)

Jilian · 08-09-2006, 10:39 AM

I hope you are able to help this mom! Has she tried calling the LC at the hospital she delivered at?? It sounds like she really needs a visit with an LC. I hope you are able to get her some help at the LLL meeting!

1stimestar · 08-09-2006, 10:55 AM

If baby's head was traumatized at birth, he may not want to nurse on that side because of a head ache. She could look into cranial sacral therapy. She needs to manage her pain from the incision before nursing too.

fearlessbirth · 08-09-2006, 01:58 PM

Jilian~ She has tried the LC at that hospital but hasn't gotten a return call since MONDAY (after leaving multiple messages). I spoke with the LLL leader this morning..she's going to give her a call today and see if she can schedule a visit. She said everything my friend and I did was great...suggested some other things we'll try as well. Wish us luck! I'm not sure if I can make it over there today or not but tomorrow will definitely go over if not today. I wish she didn't live so far away!

Jilian · 08-09-2006, 08:31 PM

She's lucky to have you! It sounds like you're doing everything you can to help this mama. Doulas rock!

Stacie · 08-10-2006, 03:43 AM

I am on a slow connection, but Reverse Pressure Softening is something you could look up on LLL's website to help find baby a nipple in the middle of all that engorgement!

fearlessbirth · 08-10-2006, 10:32 AM

When my client went to her OB yesterday he gave her some random Medela handouts on engorgement. She almost tossed them away but then thought 'what the hell' and tried the process, step by step. It worked!!! When I spoke to her last night she was so relieved...a totally different person. What worked for her was putting ice packs all around her breast, hand expressing and voila...a nipple!

She put the baby on and he sucked all that good milk right away

I am so happy for her. She was so excited and so was I. I called my friend right away to tell her the great news and it was just one big boobie celebration

My client said she's going to frame these worksheets (after making copies for me, of course.)

Thank you all SO MUCH for your help!

RosyDoula · 08-10-2006, 03:39 PM

I am so glad it worked out for you and that woman.

Babies_Bellies_Boobies · 08-10-2006, 08:18 PM

am glad it was worked out..

biw, just encourage her to keep on working on the latch to not further traumatize h er nipples.. she can express her own milk (a drop or 2) RUB INTO THE NIPPLE, LET AIR DRY, than USE LANSINOH- OR BETTER YET DR NEWMAN'S ALL PURPOSE NIPPPLE OINTMENT.

Sorry caps.

1stimestar · 08-10-2006, 09:54 PM

Quote:

Originally Posted by 1stimestar

Yes, what Kim said. Also some more tips. Ask the LLL LEADER if she can make a home visit. Cold to reduce the swelling of the tissue, heat to increase the flow, so alternate between cold and heat packs every 15 minutes. Also, Ibuprophen to help reduce swelling. The tissues swell so much that the flow is blocked. If she doesn't get this flowing she could dry up on that side or get mastitis. If she does dry up on that side, she can relactate after the damage has healed. She CAN totally support her baby from one breast though she "might" be a bit lopsided for a bit. I would start baby out on the good breast to take the edge of his hunger, then switch to the other breast. Lansinoh on the nipple in between feedings, breastmilk on the nipple after every feeding even if not from that side, and let it air dry. Yes, she does want to wear a bra for support but not one so tight that it blocks the milk ducts. Good luck.

Uh yep. Glad it worked for her.