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Subject:
From:
Laura Spitzfaden <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Tue, 29 Jan 2013 12:51:03 -0500
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PTP

Mom is 20 days postpartum and began having painful engorgement of rt breast on day 14.  Two days later she had symptoms of mastitis--hard area on lower outer quadrant of right breast, redness, fever and flu-like symptoms.  She also developed many lumps just behind the nipple.  She used castor oil compresses, rest and frequent feeding and fever was gone within 24 hours.  Swelling is down somewhat but redness and plugs are still present 4 days after initial fever.   Milk is flowing a little better but plugs are not releasing.  She continues with compresses, positional changes and some pumping which is not very productive.

Part of the problem may be that baby has some signs of PTT and consistently leaves mom's nipples pinched.  Revision is being considered but will not happen in the next week at least.  At what point should she consider antibiotics?  She is very concerned about abscess but prefers to not take antibiotics.  She has nipple cracks but no pus or significant redness of her nipples.  She has no red streaks on her breast and no fever.

Most cases of plugged ducts/mastitis I have worked with have responded within 3 days to rest, frequent milk removal, massage and warm compresses.  What is the risk of continuing without antibiotics in absence of fever?

Laura Spitzfaden, LLLL, IBCLC

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