You know, you think you're doing it right and then something happens...

We got a grant (the Health and social Services Department of our county)
which funds breastfeeding support for mothers for two months - a nurse will
go to the hospital to get their names (breastfeeding moms who fit into
certain geographic and financial parameters), then calls the day after
hospital discharge, then visits, calls or refers depending on what she
learns.

Well, she has found two moms (I know 2 does not make a trend, but we are
still asking) who were very engorged, breastfed often, used cold
compresses, etc. - then developed mastitis by day 7.

Now we assume that had she not called, these moms would have just quit and
we would never have heard from them, because I was usually not getting
referrals until week 2-4, when moms were seen at WIC,  one of the reasons
we created this program.  However, what do you do - those of you that see
moms with bad engorgement - to avoid mastitis.  Both moms had obviously
large supplies - but I have never recommended additional pumping/hand
expression to avoid maintaining this large milk production.  Would it be
better to keep the breasts soft even by using expression until the
engorgment subsides and THEN reduce expression to allow milk supply to go
down?  (thinking out loud here)

 In one case, the nipples had been irritated (not terribly, but were
cracks) the other case the nipples were fine, mom reported no pain or
discomfort in the nipples at the first (engorgement) visit.  

Jeanette Panchula, BSW, RN, IBCLC
Vacaville, CA
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