Sharon

I hope this is not too late for your visit to the mother with 
mastitis.  I think the problem described - breast care following 
mastitis - is well within the scope of practice of an IBCLC.

Firstly, I doubt that at one month postpartum she is not 
lactating.  Even if she is not breastfeeding, lactation would take 
approximately six weeks to cease altogether.

So it is likely that her mastitis was originally caused by over-full 
breasts --> engorgment --> milk stasis --> bacterial 
proliferation.  If she has mastitis now and continues to not drain 
the breasts she is at risk of breast abscess.  The treatment would be 
frequent and thorough breast drainage asap, regardless of what the 
mother decides to do with the milk (although it is a shame not to 
feed it to the baby...  Are you able to provide any input/advice for 
this mother about the risks to her baby of not being breastfed? )

But apart from breastfeeding, this mother would need frequent and 
thorough breast drainage to resolve the mastitis and to head off the 
risk of abscess.  And possibly a course of antibiotics, and close 
follow-up for the next few days.  Once all pain, inflammation and 
induration are resolved, then if she wished to suppress lactation, it 
would be good if she simply lengenthened the intervals between 
expressing/pumping the affected breast until she slo-o-o-owly stops 
producing milk.  She could use a pump to facilitate breast drainage - 
or you could teach her how to hand-express, then massage the 
lumpy/affected area, then hand express again.

I'd love to hear some feed-back on what you find and what you suggest 
and what the mother agrees to do.

Pamela Morrison IBCLC
Rustington, England
-------------------------


At 23:13 03/03/2009, you wrote:
>Date:    Tue, 3 Mar 2009 14:56:57 -0700
>From:    Sharon Jimenez <[log in to unmask]>
>Subject: Mastitis in Non-lactating Woman
>
>Wise friends and colleagues.  I need your help.  I have received a consult
>request from one of the clinics here on the reservation, but I really think
>this is outside my knowledge and scope of practice and wonder what you
>think.
>A nonlactating woman 1 month postpartum has mastitis in one breast.  One of
>the modes of treatment they have decided to use is to give her a pump.  I
>am assuming it is a hand pump.  She has no desire to breastfeed.  They want
>me to see her and make certain she is using the pump correctly.
>We do loan electric pumps and provide hand pumps, so I am familiar with
>that as part of my scope of practice.  I am not at all certain whether
>pumping is an appropriate method of treatment for mastitis since I've
>always worked with breastfeeding women.  Perhaps some or at least one of
>you will have some ideas for me.  I will go to the town where the woman is
>(about 60 miles from here) tomorrow anyhow, so I guess I could see her, but
>I feel a bit uncertain about it.  I want to tell her to nurse frequently,
>but then again, that is not her desire.
>Hoping for your ideas.
>Sharon Jimenez, RN, IBCLC
>Apache Diabetes Wellness Center
>White Mountain Apache Tribe

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