Hello everyone!
I have a mom who delivered a 32 week premie last week.  She began
pumping every 2-3 hours one day post-partum and is now putting baby to
the breast for feedings.  Baby remains hospitalized and mom stays at
the hospital on "border" status.  Baby is doing well at breast,
according to mom (I have not yet seen him breastfeed) and is having
plenty of wet and dirty diapers.  Two days ago, before baby was ever
put to the breast, mom asked me about several "bubbles" which appeared
on the tips of both nipples.  She stated they were quite small and
while she was not in pain, her nipples were tender.  We went over pump
use, proper positioning etc. and also discussed milk plugs, massage of
the breast, warm compresses, frequent pumpings etc.
        Yesterday, mom woke up in severe pain, especially on the right side.
 When she pumped, she noticed the bubbles became bigger (possibly
filled with milk?).  She also noticed a reddened area on the right
breast.  She was seen by several physicians and two LC's at the
hospital and they were all at a loss as to what they were.  Baby was
put to the breast yesterday and mom states he seems to have "popped"
the bubbles.  Today she is in a great deal of pain (mostly nipple
pain) and the nipple of the right breast is crusted over and "goopy"
as she calls it.  She has another appt. with a physician today.
        I am going to see her at noon but am also at a loss.  I have advised
her to pump/feed frequently, massage the breast before and during,
warm compresses to the nipple, etc.  Would a nipple shield be in order
here?
        Also, this mom has been running low -grade fevers since birth and
says her lochia has a funny smell, though would not characterize it as
foul. (of course I have advised her to mention all of these things to
her physician).
        If anyone has any insight to this I would appreciate some guidance.

        Thanks,
        Kirsten Clary, RNC
        Family Advocacy Nurse Specialist