Hi all,

Need a bit of info - have been checking the archives and if ayone has any more to offer I would appreciate it very much.

Permission to post - client lives in rural location, g1, p1, hospital birth with midwives, GBS+ (think this may play in here...) client tried many many ways to treat GBS to avoid use of anitiotics during delivery but couldn't "get rid" of it - mom is massage therapist and is very wholistically inclined - ended up on antibiotics anyway at delivery, vaginal birth, healthy term baby.  Mom had massive supply and of course tender nipples (while under care of midwives treated for thrush due to abx use) though I felt that baby was clamping to reduce flow and protect airway.  Ist saw client when baby was 15 days old.  Discussed methods of reducing supply, coping with strong letdown...positional issues due to previous back injury and carpal tunel/sore wrists but mom understood principles of lowering supply, FIL, keeping supply balanced, both breasts evenly emptied to avoid having one side become overly distended, difficult to latch onto and difficult for baby to manage very very strong letdown.....stressed importance of keeping breasts soft-ish and milk moving.  Tried to work on latch.  Mom had double electric pump and knew that over (any!) pumping could work against her efforts to reduce supply but sometimes pumped briefly if nipples were to sore and fed baby EBM.  Baby gaining like gangbusters!  Due to mom living quite far out of the city and not having car most follow up was by phone, she was having regular 6wk pp care by midwives as well.  Mom contacted me with concerns re: plugged duct, we had dicussed impt of watching for this while working to reduce supply.  We discussed massage, cold compresses to reduce inflamation, warm to help with flow just prior to feeding, importance of deep latch, etc... Tried to get her to pump to drain and "start fresh" on empty breasts but even pumping was uncomfortable and mom was home alone with no support to help with baby.  Nipples were still sore due to difficulty with positioning.  Plug became stubborn - see where I'm going with this? - mom not well, though there was no fever at this time but lump was inflamed and a bit red (mom not sure if this was due to vigorous massage).   Discussed U/S treatment *only* if no signs of infection - told mom to be very careful, that therapist wouldn't do U/S if any signs of infection present.  Midwives also discussed U/S.  Mom had treatment - yikes!  1st question: Anyone know what that would do to an abcess?  No improvement, now showing clear signs of fever, infection....went to small rural hospital, doc said "plugged ducts - go home and pump, massage and nurse" - with encouragement mom went to larger hospital in city, abcess dx, some gunk aspirated out of 2 locations and mom sent home with oral abx (not sure which ones at this point).  I went ot her the next day and help with gentle massage, hand expression/some pumping but mom was very very sore.  We discussed pain management, preservation of supply, baby not nursing on this side at all.  2 days later much much worse, went back to same (city) hospital, this time 60ml+ of gunk drained with needle aspiration and IV antibiotics (had to travel in to hosp 2x/daily for this!).  After several days of IV treatment 2x/day she then went down to once/day (as per instructions) then d/c the IV and continued oral abx (actually think she had a 3rd drainage in there somewhere.....).  Friday past she thought she was getting better, no fever, less pain, able to continue to pump/hand express (my preference in this case) but by Sunday was sick again and lg lump again visible.  But here is the thing....the lump moves - is the abcess being "pulled' through the breast by the pump or manouvered around by massage??  I have been asking her not to massage the area where the abcess was/is of course.  Are there multiple pockets that flare up one after the other??  I have a colleague who maintains that antibiotics don't touch an abcess since it is walled off from the body (and that moms with abcesses often do not present with fever - but that isn't so relevent in this case) but I wonder about the flare up after d/c the IV antiboitics, of course there seems to be a relationship.  I have read Robin's 2008 posting on I & D and wonder if anyone has any more info or comments on this...........has anyone successfully treated with aspiration and abx?  We are at the point of "hands off the breast" - very little manipulation at all and no pumping as current lump is at and surrounding the nipple and is very very painful.  Will likely allow involution and attempt relactation after healing, baby doing well on exclusive nursing on other side.  Any support welcome!!  Have cultured, no one has mentioned MRSA (except me - she forgets what the doc said).  Has abcess ruptured into ductal system??

Thanks

beth in ottawa (ibclc and lllcleader)

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