My client who had recurrent abscesses a few years ago (search the archives for recurrent mastitis/abscess and my name!) just birthed her second child on Sunday morning. I saw her today and her milk is flowing, but not too easily from the previously-affected right breast. After she weaned from using the right side (and continued with the left side to the surgeon's consternation...all the way until her firstborn self-weaned at 18 months during this pregnancy!), it was always a bit tender and firmer than the left side, but today she winced with even light touch. She is not clinically engorged, just normally full. The left side looks great...full, but not hard. However, her right breast is so incredibly painful that she is not tolerant of her baby nursing on that side. She has been, but we talked about even the emotional aspects of doing so and she admits that there is a fear factor involved on top of the incredible pain.
Short version. She decided today that it would be more comfortable to pump the previously affected side and just nurse on the left, although it makes her new mommy job a bit harder with the pump in the picture. There were several reddened areas on the right side that concerned me and she is willing to try anything to avoid surgery again. She's using RPS prior to nursing (and now pumping), she's using some ice for comfort, ibuprofen...any other suggestions? She has a large cyst (diagnosed by U/S during abscess adventure) under her areolar/nipple complex that makes it difficult to latch.
There aren't written case studies for this...she *is* the case study. Her breast has multiple scars from the multiple abscesses, but it's not like a post-reduction or post-augmentation breast. I read Liz's post for Diane DiSandro about kneading the breast--it would be a great idea, IMHO, but this mother cannot cope with that. She was a trooper through her first nursing experience and endured more pain than any other client I've had, so she's not a wimp, but even light touch is too much for her right now.
Her doc is on board with nursing (he's an FABM), but he's looking at me and I'm looking at him. Is it stupid to do something prophylactically? She has Jan Barger's homeopathic recipe for mastitis and grapefruit seed extract.... Help! Oh, and her family is moving this upcoming weekend...a little bit of stress and fatigue going on, so I am very concerned about mastitis, which, in the past, quickly moved to an abscess.
Welcoming your thoughts,
Rebecca DeYoung Daniels, MBA, RD, LD, IBCLC, RLC in KS
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