What to do??

I was contacted by a mother, baby eight weeks. She had  mastitis, two times
a week for four weeks now.  Alternating between breasts. She told me her
breasts had never been 'empty' since birth. Her baby was drinking from one
breast only two to three minutes, spitting up lots of milk, having very
loose stools, growing almost too fast, needing a pasifier to fulfill his
sucking needs. When she called me her temperature was over 39oC and she felt
very weak. Her first baby was breastfed for month without any problems 13
years ago. With the second baby she stoped breastfeeding because of
recurrend mastitis, 4 years ago. This is her third baby and she asked my advise.

I have been thinking about this problem and came to this conclusion.
First of all, the mother should get rid of the mastitis and since there was
no possibility the baby was able to drink it away, we had to do it by
pumping. I advised her to empty both breasts. We pumped one breast, 250cc
let the baby drink the other and pumped that one too. Than I had her pump
the good breast, give the other breast and pump afterwards for two days,
until she felt the mastitis was over. Than I advised her to only pump when
she felt one of her breasts was getting overfull again. We kept in tough by
phone almost every day. She told me everything went fine. The baby drank two
breasts per feed, taking a lot more time, his stools were improving, he did
not need a pacifier anymore. We both felt we beat the problem. Today she
called me again, one week after my visit to her. She told me her condition
was back to normal, she had lots of energy again, but her breasts were
filling up again too. So she is getting back to her previous condition with
way too much milk. What else can we do but pump when she is getting
overfull, like once every one or two day's?

Siemian Berghuijs, IBCLC, the Netherlands