I posted last week about a mother with a breast infection, large lumps, etc.
Now, I need some straight answers from you.  Do you always recommend
antibiotics for a br. infection?  Do you mention the risk of yeast from
anti.b. use?  Have you weighed the risk of abscess against the risk of
yeast?  Where have you settled?

This mother didn't want to take ab. if she could avoid it, as she knew
several people who had done long battles with yeast.  She is a primip. and
trusted me enough that she would have taken the ab. if I had "scared" her
with the risk  of abscess.

After a few days of getting better and regressing (due, in part to a baby
who sleeps) I urged her to fill the prescription that I suggested she have
written early on.

Am I trying to excuse myself here?  What I have is guilt and a sense of
incompetence because she may have an abscess now.  I know that I make
mistakes but when someone else suffers from it I find it hard to live with.
The alternative is to not do this work at all.  I could have persuaded her
to take the ab., but I have known so many mothers who handled a br.
infection without ab. and the two other abscesses I have worked with were in
mothers who did take ab.

The reading I've done is heavily weighted toward always using ab.  And yet
we are trying to decrease ab. use.

So my question is, do I always urge ab. because if there is an abscess I
won't feel so responsible?  And what of the high risk of yeast overgrowth?

I'm trying to comfort myself with Br. David Steindlerast's words:

"We must always choose between risk and risk."

What do you say, dear Lactnetters?

Pat Gima, IBCLC
Milwaukee