Hello,

This is my first time to post. I have permission to ask for suggestions for a mom I am working with. 

Mom is 9 weeks postpartum from a spontaneous vaginal birth at our free standing birth center. She had some intial nipple soreness improved with positioning assistance. Then was diagnosed with postpartum depression at 3 1/2 weeks and prescribed Zoloft. She was having pretty severe anxiety and couldn't sleep and elected to pump and have Dad give bottle for 3 days (she didn't trust herself to hold or nurse baby during that time because of her own crying jags). She had pretty good resolution of her depression in about a week with the meds and counseling, and returned to regular breastfeeding, feeling good about baby's good health and weight gain. But 2 weeks later at her 6 week postpartum visit she complained about a right breast golf ball sized lump that had been there for several weeks. She was afebrile, breast was not red, swollen, or streaked. Both the nurse practitioner and one of the midwives felt it was a plugged duct. So she was sent home with good instructions and to call for any changes. 

When the lump was still present and worse after she returned from a week at the beach, she came in with obvious mastitis. The lump was enlarged, breast was engorged with widespread erythema, and baby refusing to nurse on that breast, also low-grade fever. She was treated with Keflex and advised to pump, but there was no change after 72 hours. So she had an ultrasound to evaluate for abscess and a visit with the breast oncology nurse practitioner (who is also familiar with breastfeeding problems). Ultrasound was negative for abscess, but there was a galactocele present, as well as several enlarged lymph nodes. All was attributed to mastitis. Her antibiotic was changed to Clindamycin. She had follow-up ultrasound today, which was fairly stable: no abscess, galactocele same size. Mom thought the breast was worse or no better, but the NP felt there was improvement. Still mastitis but more localized to the inner aspect of the areola.

Problem is she has not been able to put baby to that breast for 10 days, pumping has been ineffective, and she can only hand express while in the bathtub after soaking the breast. She has good milk flow then from the outer half of the breast, but no milk from that inner half. I think she is only hand expressing this way twice a day, but has been breast feeding on the left breast regularly. She is about ready to wean, but afraid to let the left breast fill because she can't deal with another episode of mastitis. 

What can she do to relieve engorgement/get milk flowing on that half of the breast when the pump is not effective?

Over my head in NC,
Nancy Albrecht, RN
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