Hi All, 
  I could use some help on a case I am currently working on. I saw a mom last week in our hospital outpatient clinic whose Ob had sent her in.  Baby is 6 weeks old. Mom had severely engorged breasts and pain (itching, burning, stabbing).  She stated she could not get the milk out of the L. breast, but that the Baby did fine on the right.  We tried manually expressing and using a hand and electric pump.  The L. breast only had milk dribble out of one opening.  Dad of the baby says it has always been this way.  Baby effectively emptied and softened the R breast.  (mob is using nipple shield as her nipples are very short and tissue surrounding is non-stretchy - baby was unable to latch during first week or two of life and mom pumped and bottle fed).  Dr is planning an ultrasound but wants input from Lactation.
  We had her use cabbage on that side, along with ice. After 3 days of this treatment she still could express no more milk and only one duct opened according to both mom and dad, but breast did soften and was much more comfortable.  She also used Gyne-Lotrimin and the pain went away. (She had a vaginal yeast infection 1 month ago.) 
  However, when we called back this week, her L breast had again become engorged.  Mom went back to using cabbage and ice.  Dad says that mom had a breast injury during pregnancy, I don't remember the details except it was not a major trauma. Mom has not had breast surgery. Upon palpitation, it is very hard, full and feels similar to a breast with severe engorgement on day 4 postpartum, but the right felt the same when she first came in. The left breast is not red or warm and mom has not felt ill. Would lymphatic massage  be of benefit?  Does anyone have any other suggestions or ideas?  Thanks so much. 
 Judith Markham IBCLC RLC RLLL
Tri-City Medical Center
Oceanside,CA

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