I am attempting to help a mother with a post mastitis situation and thought
that perhaps some of you have helped with a similar one. The mother is a
physician with her first baby, (who is breastfeeding well and thriving). Both breast
were the same size and we felt were producing approximately the same amount
of milk until three days after the start of a mastitis. I would like to suggest
ways to increase her breast milk supply from the affected breast with
fenugreek (she has been feeding more frequently from the affected breast in an
attempt to increase the supply) but I
am concerned that the unaffected breast will start oversupplying. She sent me
the following description of what has happened and would also like to hear
from you. I will be forwarding all information to her and this is sent with her
permission.
Thank you very much,
Nancy
I am a 33-year-old general surgeon, G1P1, the proud mother of a two-month-old
baby girl. Three weeks ago I noticed some soreness laterally in the left
breast, but did not give it any further thought at the time. [In retrospect, I
had worn a cheap, underwire nursing bra the day before, as I was doing laundry.]
The following day it remained sore and there was a lump in the upper-outer
quadrant. I felt very run-down, which progressed to fever, chills, headache
and nausea that night. By this time, I felt that my likely diagnosis was
mastitis. By the morning my fever had resolved with Tylenol and ibuprofen,
although I had developed a faint area of erythema (redness), approximately 6 cm in
diameter, over the upper-outer quadrant. I saw my obstetrician later that day,
who confirmed the diagnosis, although there was not any significant erythema
or swelling of the breast at that time, and started me on a 10-day course of
Keflex [I am allergic to penicillin].
The fevers never returned, the erythema resolved and the pain began to
improve almost immediately; however, over the next three days I noticed that there
was a large (5-6 cm) lump in the upper-outer quadrant of the left breast, and
that the remainder of the breast was very soft and empty-feeling. It was also
significantly smaller than the right, approximately one cup size. I had been
continuing to nurse on both sides throughout. After 72 hours, I felt that
there was little or no milk in my left breast, as my daughter would begin to
nurse and then pull off, screaming, and I was unable to express any milk as well.
I phoned my obstetrician, who suggested I call Nancy that afternoon.
While on the phone with Nancy, with additional direction I was able to
express a few drops from the left breast. It appeared that I had plugged ducts. We
decided that the best course of action was to continue to nurse on that side,
but nurse lying down with my daughter facing opposite to me (with baby's chin
towards the lump). We also began soaking the left breast in Epsom salts 2-4
times per day. There was very little change over the next several days.
Nancy had advised me that I would likely see a whitehead on my nipple, and “
stringy milk,” neither of which I saw. I felt well throughout. We spoke daily, and
I was convinced that I did not have an abscess, although we did discuss
obtaining an ultrasound to rule it out definitively. I did leave a message for my
OB in the OR, which was never returned, to discuss it; but by the next morning
the feeling of a lump had resolved. This was one week after starting
antibiotics.
Over the next several days I resumed my normal nursing patterns without
difficulty. The left breast was still smaller that the right, although the
asymmetry was not as pronounced as a few days earlier. After a few more days,
however, the symmetry did not return, and I felt very little let-down on the left.
I began to nurse more frequently on the left than the right, although this
has only served to make the asymmetry more pronounced. As of now, my right
breast has a strong let-down, and feels firm and heavy before nursing, while my
left is nearly a cup size smaller, has infrequent, weak let-down, and when it is
at its most full, feels very firm laterally, and empty medially.
Nancy Paronich RNC IBCLC
Sue Simmons RN IBCLC
Maternal Experience
PO Box 67
Marshfield, MA 02050
781-834-4600
Fax 508-746-1663
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