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

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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?

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Breastfeeding following lumpectomy and radiation therapy for breast cancer

Question
I am a physical therapist, childbirth educator and lactation counselor from Israel, temporarily residing in the States. I have a question about breastfeeding after radiation therapy for breast cancer.  The woman is 42 years old. She has a 7 year old son whom she breastfed for 2 years. Her milk supply was high during that lactation. She is now 17 weeks pregnant. A year ago she had breast cancer in her left breast and had a lumpectomy, radiation and some lymph nodes removed.  The “affected” breast has not grown as the other one has during pregnancy. Read the rest of this entry »

Birth Trauma, Tongue-tie, and Low Milk Supply

Question
I am currently assisting a 38-year old first time mom with an 8-day old term infant.  Baby was born in a Baby Friendly hospital facility and weighed 8 lb 3 oz (3712 g).  On day 8, infant weighs 8 lb (3627 g). Read the rest of this entry »

Infant’s Retracted Upper Lip and Maternal Nipple Trauma

Question:
I am struggling to assist a woman with a newborn, 4 days old who is causing trauma to the nipple.  The issue appears to be the infant’s curling upper lip.  The baby’s upper labial frenulum is tight and the lip is difficult to uncurl while on breast.  Mom’s nipples are small; her breast and areola large.  Baby takes best with cigarette type hold on areola.  I can get baby in good position, but mom cannot get baby on without pain on top of breast where lip curls in.  Mom is coming in today for follow-up after discharge.
Cynthia Sales

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Flavor and Odor Changes in Stored Human Milk

Question:
I work at a small rural hospital in beautiful NW Montana, and lead a Mother/Baby Group weekly. I get a lot of breastfeeding questions, and one which has come up more than once recently, and which I have not been able to find an answer for is about breast milk that has been frozen and then thawed to use when the mom has to work. The baby will refuse to drink the thawed, warmed milk, supposedly because of an enzyme, or something similar, in the milk which makes it tastes bitter.  I reviewed the mother’s procedures for storing the expressed milk, and then how it is thawed and warmed, and she seems to be following the correct procedure. I have never heard of this before recently, and now I have had a couple of moms ask me about it.  Can you shed any light on this for me, and is there any solution to it?
Thank you so much,
Debbi Foss, RN, Lactation Specialist Read the rest of this entry »

Placenta Accreta and Complications of Lactation

Question: I am working with a mom, 2 weeks post partum who has placenta acreta.  Her baby is in NICU.  She has very little milk.  The doctors are hoping that the placenta will reabsorb and we are wondering if she keeps pumping if there is a chance that she might begin producing milk later on.  I am wondering if you have worked with a mother with this problem before.  It’s my first time.
Jean Geurkink, IBCLC Read the rest of this entry »

Fluid Leaking from the Site of a Procedure to Investigate a Galactocele

Question: I have a patient who underwent a needle biopsy of a galactocele.  A week later, she continues to leak fluid from the entry site on the upper lateral aspect of her breast. I don’t know much about galactoceles.  How does she get the entry site to heal so that it will stop leaking?
Heather Henry, RN, IBCLC Read the rest of this entry »

Information about topical Bactroban (mupiricin) use for nipple trauma

Question:
I am a Public Health Nurse working to support breastfeeding families. A physician has asked for information about topical Bactroban (mupiricin)  use for nipple trauma. I shared information about this drug from Thomas Hale’s, Medication and Mother’s Milk. Are there any additional  research/articles regarding Bactroban that I can reference?

Also, I am familiar with the All Purpose Nipple Ointment (APNO), however, in a situation where the all purpose nipple ointment does not seem to be effective, might there be an advantage to trying Bactroban on its own?

Susie Wood BN RN
Public Health Nurse, IBCLC Read the rest of this entry »