Nikki Lee Health

The case study of SM has been in my files for nearly 40 years. SM’s story deserves to be shared because she breastfed each baby for over a year using an Davol nipple shield hard plastic base with a Gerber bottle teat on it, as shown below, and, had leaked more than any mother I’ve ever encountered.  I’ve never heard of such a case nor worked with such a mother ever since. Humans are creatures of infinite variation, and SM is an example.

According to all the current lactation physiology and breastfeeding management guidelines, she should not have succeeded at breastfeeding.  Nipple stretching sends a message to the pituitary gland to release milk making and milk moving hormones. Without nipple stretching, there is no message to send. Use of a hard plastic shield is another barrier to nipple sensation, and hence, to milk making. Yet this mother made so much milk that her babies grew well.

SM was told long before she became pregnant that her nipples were inverted. When I examined her breasts, as part of working with her after the birth of her second child, it looked like there were holes where her nipples should have been. I wish that I had been more thorough in my examination; however, as this case was at the beginning of my work with challenging breastfeeding cases, I did not have the knowledge or experience to explore further. Now I wish I had put on gloves and done some palpation.

SM assumed that she would be able to breastfeed because she had a friend “with no nipples” that did. After the birth of her first child, her baby was unable to grasp the breast.   A postpartum nurse gave her the Davol nipple shield, a common style at the time, and one that can’t be found anymore. SM preferred the Gerber silicon teat because it had a ridge inside that fit the Davol base best, and also had a flange that kept the baby from taking the whole shield into its mouth.

This picture shows SM’s breast immediately a feed,  after baby had latched onto the shield and gulped away for seven minutes before letting go, satiated.

SM’s major concern was leaking.  She leaked all during pregnancy. After her babies were born, she leaked continually, and between 2 and 4 ounces during a feeding. She described her leaking thusly: “I never don’t leak. I use 2 breast pads every time I nurse. With my firstborn, I had to change between nursings but with my second, I didn’t. I leak non-stop; you kinda get used to it. I can’t wear a bra for two days in a row. I can’t wear a shirt for more than 6 hours. I sleep with a pile of washcloths next to the bed and change them all night. It’s really awful, everything is soaked. I don’t know if I leak more when I have an orgasm.”

SM found nursing outside her home to be a challenge as she was unable to be discreet. “I can not nurse discreetly in public because I have wet breast pads everywhere.” She had another complaint about her situation: “The only thing I envy about people who don’t use nipple shields is that they can walk and nurse at the same time. I can’t walk and keep the nipple shield on.”

My speculation is that SM lacked sufficient musculature to either form a nipple or close a duct; this would explain both the lack of nipple formation and the constant leaking.  She denied any metabolic problems, any medical illness, or breast surgery.

Imagine dealing with breasts “like geysers, with milk spurting everywhere”. Imagine the constant nuisance of milk on clothes, bras, and sheets. Imagine choosing to be confined to home much of the time, unable to breastfeed comfortably outside the home, and continuing to do it because of a commitment to breastfeeding.  If ever there was a mother deserving of an Olympic gold medal for breastfeeding under adverse circumstances, SM is that mother.