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Clinical Crossroads |

A 35-Year-Old Woman Experiencing Difficulty With Breastfeeding

Ruth A. Lawrence, MD, Discussant
JAMA. 2001;285(1):73-80. doi:10.1001/jama.285.1.73.
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DR DELBANCO: Mrs C, a 35-year-old communications professional, has a 3-week-old child and has been experiencing difficulty with breastfeeding. Married and living in Boston, she receives care from an obstetrician-gynecologist, Dr T, at the Beth Israel Deaconess Medical Center and has commercial health insurance in a managed care plan.

Mrs C experienced menarche at age 12 years, had a miscarriage 2 years ago, and gave birth after an uncomplicated pregnancy to her first child. She ruptured membranes on her due date and had a vaginal delivery aided by oxytocin and epidural anesthesia. During pregnancy, she noted mild breast enlargement without nipple discharge. She attended prenatal classes at the hospital, including 1 focusing on breastfeeding, something she felt important for both her and her child.

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Figure 1. Presentation of the Breast and Latch-On Response
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Figure 2. Mechanism of Breastfeeding
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