Dear All,

A while ago (i.e. before Christmas) I posted about a woman who was pregant
with her 6th child. My questions were regarding what (extra) we could do to
reduce her chances of getting mastitis. With her previous babies she had
nothing but mastitis (infection present) and did not continue to bf them
(apart from one). This time she has given birth to a girl (after 5 boys!)
who is now almost 5 weeks. Her milk came in within 6 hours of the birth, but
she did not suffer from the enormous engorgement she had with the last
babies. The first week was still difficult though, because her daughter was
not able to latch well due to large nipples and small mouth. Thus she used a
nipple shield for the first week until a LC and myself stepped in to help
with the latch and over the coming weeks managed to wean her off the nipple
shield from the left breast. We are now almost there with the right breast.
At the moment she is able to latch well (that's how it seems to us - no
pain, nipple problems etc) on the left side. The right side is getting
there, actually, it's now nearly as good as the left side now.

During this time of getting the latch good, she has been expressing milk
after each feed and giving extra with a syringe. This she is now building
down as her daughter is getting stronger, growing well, lots yellow nappies
etc and better at drinking directly from the breast (no nipple/areola
problems). The problem is that she is getting blocked milk ducts with
inflammation a couple of times a week (including high temp. and flu like
feeling).  When this happens she takes some ibuprofen  for pain and
inflammation, and uses warm massage to relieve the block ducts. She also
still expresses milk a 2 or 3 times a day, due to her oversupply (which is
ofcourse contributing to the blocked ducts). She feels if she does not do
this then the risk of full blown mastitis is only around the corner. She
also does not mind expressing (she drinks the milk herself or gives it to
whoever is around at the time).
This way she is able to keep on top of the problem. She has tried all sorts
of feeding positions, which don't seem to help prevent the block ducts and
inflammation. The block ducts and red, inflammed areas also seem to occur at
random sites in the breast. This makes us think that it is not necessarily a
latch problem?

It seems to all of us that she is extremely sensitive to blocked ducts /
inflammation in her breasts. When not lactation she hardly ever gets sick, a
winter cold at the most. She is also taking a vitamin and mineral supplement
to give herself a boost.

My questions for her are:
The oversuply is probably contributing to the blocked milk ducts and
mastitis - but she and I too, are worried about stopping expressing the
excess milk due to her sensitivity to mastitis. I have suggested that she
build it down extremely gradually over a long period (more than 2/3 weeks).
The idea of feeding from one breast for two feeds to give negative feedback
a chancce we also don't want to try. She has noticed that if she doesn't
feed on time, then she is guarenteed a blocked duct.
Any helpful suggestions are welcome?
She clearly and naturally wants to avoid full blown infectious mastitis and
is thus reluctant to let her breasts become too full during reducing
expression. And definitely wants to continue breastfeeding.

Although, this is probably not going to help the current situation,  - can
all her previous histories of blocked ducts / mastitid mean that her ducts
are scared and thus now even more sensitive to inflammation and infection?

Aside from oversupply problems leading to blocked ducts or mastitis, does it
appear that some women are just very much more sensitive to this sort of
problem? Or is it purely due to the oversupply? Could there be a low grade
bacterial infection in her breasts? Would a long course of the right
antibiotic bring her out of this situation?

At the moment she is just keeping on top of the problems. We were also
wondering whether that at around the 3 month mark her milk supply might
naturally decrease anyway?

The whole situation is very problematic, although the mother herself is
becoming more and more optimistic with every week that goes by, although she
is still very nervous that the big infectious mastitis episode could be
lurking around the corner. I'm hoping that over time, the blocked ducts and
mastitis will become a thing of the past if we could just decrease the
supply a bit.

Thus, any wise input is welcome!

Thanks in advance

Sara Bernard
The Netherlands

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