I wrote on April 15 about a baby born April 10 whose mother was producing
large, gelatinous blobs, just as she had with her first.  Nursing was
painful, as if he was bruising her, but pumping hurt, too, and her nipples
seemed traumatized either way.  The largest blob was several cm across (yes,
cm), like a bloody yolk in egg white.  Left to sit, the whole dish turned to
soft jello, then later liquefied.  The blobs - all of them milk-colored
except for the one large bloody one - wouldn't pass through a bottle teat.

She started on dicloxycillin when one breast seemed a bit red, but there was
no fever.  Nothing had seemed to help last time, and she had ultimately
weaned off the worse side completely, resuming nursing on the better side
after weeks of pumping and a period of complete weaning, reestablishing a
partial supply and painfree nursing on one side.

*You* folks were no help, and neither was the Lactation Study Center in
Rochester (gosh, hasn't *anyone* seen these things??), so I called the dairy
mastitis lab here in town, figuring if anyone knew milk oddities they did.
Sure enough, they're familiar with blobs in dairy cows and goats.  The blobs
generally accompany mastitis or severe engorgement, and large bloody blobs
aren't uncommon in the first week.  They had the mom come to the lab and
pump for a culture and to show them the blobs.  (Part of the sample protocol
was for her to swab her nipples with alcohol "until the swab comes away
clean... though probably with a human that would happen on the first swipe,
wouldn't it?")

By the time she got to the lab, she had stopped producing blobs *except if
she nursed*, after which the next couple pumpings would contain blobs.  She
believes they formed only after the milk stood, and she could cause them to
disintegrate by pouring the milk back and forth from one bottle to another
several times.  The lab never got to see them, and felt they were resolving
because of the dicloxycillin.  I haven't heard an explanation of why nursing
would continue to produce blobs when pumping gradually stopped doing so.

I haven't seen her lab report yet, but she said her milk grew "all sorts of
stuff", most notably a heavy overgrowth of Staph aureus.  She wonders if she
could have been harboring an infection from before the birth of this baby,
for it to flare up with such ferocity within a couple days of his birth.
According to the lab, S aureus has a coagulating factor in it, which could
account for the jello response.  I have no idea why we don't see it more
often.  This mother has had it with two babies, and I saw one other mom who
seemed to produce blobs in response to mechanical trauma rather than
mastitis - possibly the reason the current mother continues to see them with
nursing.  But they're apparently more common in cows and goats than in us.
Or maybe, the vet pondered, vets just see worse mastitis than a doctor or LC
would, because vets aren't involved until an animal is obviously sick, where
we're alert to every twinge and color change.

She had reluctantly decided to wean, the problems and pain being more than
she could handle on top of 2 children and other responsibilities and
stresses.  But after shutting down the bad side and beginning to taper off
the better side (pumping for comfort and nursing once a day because she
really wanted to) she found that she was having more good nursings.  We're
both cautiously optimistic that, given more time to heal, she can nurse on
both sides with a full supply, though I've encouraged her not to do too much
direct nursing  until both breasts and nipples are pain-free and blob-free.

Using a vet lab meant we were dealing with people who *knew* milk, who were
accustomed to thinking outside the box (not all their clients, after all,
are even the same species), and who gave her additional attention because it
was an interesting puzzle for them.  If we need more head-scratching over
this, we sure know where to go...

Diane Wiessinger, MS, IBCLC  NYS

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