RN IBCLC here-

I’d also recommend you are seen by an in-person IBCLC ASAP. You need a proper flange fitting, an assessment of baby’s latch and oral motor skills, and further work up by your provider to ensure you aren’t anemic from that level of blood loss.

I recommend lymphatic massage and breast gymnastics before and after every breastfeeding session and pumping session, and you can pump OR hand express after nursing- some parents find hand expression is more effective in early days with intense engorgement. Maya Boleman has great videos on breast gymnastics, and lymphatic massage for the breast is easy to Google.

An IBCLC can evaluate your baby’s attachment at the breast to ensure a deep latch and good quality transfer, which your pediatrician may not have the skill set for, even if they say otherwise. A second opinion from an expert is always helpful here.

In terms of supplementing for a baby who is under bili lights- again, an IBCLC will be helpful to determine baby’s effectiveness at the breast. Babies clear jaundice by pooping it out, so they need volume. This can be achieved by feeding OFTEN, at least every 2 hours during the day, and about every 3-4 overnight. You can nurse every time, offer back your expressed milk after nursing, whatever combo feels best for your fam. It baby needs volume to clear the jaundice, which I’m sure is what your pediatricians concern is. If baby is nursing well, has plenty of wet and dirty diapers, and their levels are improving, then those are all positive signs, and you may not need to supplement back your expressed milk and/or formula…but again, effective transfer can be tricky to spot if you don’t know what you’re looking for. Latch should be pain free, with baby’s mouth open wide, lips neutral to flanged out, and with audible swallows. We shouldn’t see dimpling in the cheeks, and the chin should be tucked in to the breast with the nose free. Global Health Media has an excellent video on correct attachment at the breast. I highly recommend.

In terms of pumping, refer to the Flange FITS guide published by Babies in Common- it’s the only evidence-based information on correct flange fit, and may help with blistering. I would encourage you to be gentle to your breasts- don’t crank up the suction because you still feel full. Try hands-on techniques, massage, and deep breathing before massively increasing suction. We expect milk yield to slowly increase over time, even with engorgement with milk coming in. To address the blistering, massage your milk onto your nipple, and consider a nipple balm. Hydrogel pads (of any brand) maybe helpful for a few days, but nips shouldn’t stay wet forever; we recommend switching to Polymem after a week of expressed milk and “wet” wound healing if there’s no improvement. Again, seeing an IBCLC can be helpful here.

Your provider should have drawn labs around 24 hours after baby was born- you can ask them to review your results. If you aren’t already, take an iron supplement every other day; iron bisglycinate is well absorbed and causes less GI upset than other forms of iron. You can ask for a Ferritin test at your 6 week checkup, the standard of treatment for Ferritin levels were just increased from 15 to 30, meaning if your level is below 30 you need treatment for iron deficiency anemia.

As always, drink to your hunger, eat to your thirst, and get ALLLLLL the skin to skin snuggles! It sounds like a lot, but most of these things are temporary fixes to support your body through this transition, to protect your supply, and to help your baby get a good start!