Hi Allison,

That poor mother! I think it is pretty important for someone to see
her in person, if at all possible. To examine the nipples in person
and to actually observe her pumping (with both pumps). But why does
she pump at home with a lactina, did she have too much pain to nurse
the baby when home? Another issue may be hygiene, is she cleaning her
pump parts appropriately, or does the work environment or time
constraints interfere with that? Bacterial and fungal growth can
really proliferate if not doing proper cleaning.

This might not be a popular statement, but I don't think the treatment
of thrush needs to be a complicated process. General washing of hands,
clothes, and pump parts (I really don't think most women need to "go
all out" with the boiling and vinegar, etc), and applying an
antifungal or taking a systemic antifungal med.
On the other hand, as we have talked about and read studies about,
sometimes the mother actually has a bacterial infection or
co-infection and needs antibiotic treatment of some kind (I realize
the baby had a thrush diagnosis, but still).

Even if it seems that things get worse at work and I'm sure they do,
this mother may find that some adjustments to her bf position, latch,
support of breast and baby, can all be facilitated by a bf supporter
who also observes her the baby. After all, we did hear recently about
busy mothers feeding babies practically "hanging on by a thread" to
her breast as she directed the goings on of the family around her.
(Haven't we all done that? Ha!).

Another thought would be the use of the pump (I agree with you, try to
get the best flange fit) as far as speed and suction. I have seen
several mothers who have the dials mixed up, don't really understand
the use of the faster speed (stim phase) and the slower speed
(expression phase), or with the Lactina don't know that the suction
setting is on the plastic arm and not the 1-7 dial, e.g. One last
thing, I really don't care for lanolin, especially past a minor
tenderness type of pain. I don't know if it contributes to problems or
just delays proper treatment, if it is contaminated by constant use
from tube to fingers to breast, but I usually have moms stop the
lanolin if they are using it at a point in their pain/injury like
this. I just don't see lanolin as necessary or really very helpful,
although it's use seems to be ubiquitous.

Laurie Wheeler RN MN IBCLC
Mississippi USA

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