Hi all,
 
PTP.  Mom has had a plugged duct since Monday -- upper, mid-outer  
quadrant, right breast.  Baby is 4 months old, nursing well.  First  plugged duct.  
Did the hot compresses, frequent nursing, taking baby to bed  with her, 
pumping....no avail.  Saw her midwife who had her call me.   I, of course, am 
always suspicious of an abscess if people doing the right thing  for 48 hours 
with no resolution.  Talked to her on Tuesday, tried the comb  trick.  On 
Wednesday called her back and she told me about a nipple bleb,  so I talked 
her thru that -- we talked on Thursday, and she had been able to  scrape the 
bleb off, the breast emptied, the hard spot went away (as did the  painful 
breastfeeding) and all was well.
 
For about 12 hours.  Then the plug came back.  I suggested round  the clock 
ibuprophen in case there was inflammation there, lecithin, continue  
compresses and gentle massage with frequent nursing.  She only works one  day a 
week, pumps during that time.  Normally gets 4 ounces from that side  when she 
pumps at work, now down to 2 ounces.  Went back to her midwife who  put her 
on Keflex.  No fever, no redness, no real discomfort (since she got  rid of 
the bleb), except this hard spot that won't go away.
 
What am I missing and what can I suggest?
 
Jan Barger, RN, MA, IBCLC,  FILCA

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