I have a mother who is 2 days post delivery. This is her second baby. She
BF her first baby for 3 months and stopped due to yeast. She is positive
for Beta Strep. She is terrified that the same thing is going to happen
again. She has given me permission to post.
Her baby was a vaginal delivery, with an uncomplicated delivery. She
received an epidural at 7 cm. She was given 3 doses of Antibiotics IV
after delivery. She has taken Acidophilus once a day for the last 2 months
of pregnancy.
Upon exam, her nipples are slightly pink, with no cracks. The L areola has
a natural crease in it. The right breast has tiny blisters on the nipple
that are almost invisible. The baby was positioned incorrectly at the
breast. He has a VERY strong suck (the Dad is 7 feet tall and played
basketball in college--this child is headed in the same direction) and
hunches up the back of his tongue. The mother states even with correct
positioning, the pain is exquisite during the entire nursing session. She
limits his nursing to 15 minutes/breast, and nurses on both sides. The
baby nurses every 3 hours to feed, and does not wake sooner. He appears
content after the 15 minute feeding per breast. He is stooling and peeing
very frequently. His birthweight was 8# 1oz., and lost to 7# 14 oz. at 24
hours. He is slightly jaundiced. The midwife prescribed one Diflucan
tablet only and 600 mg. of Motrin every 6 hours.
The mother stated that she felt that she had an oversupply of milk with her
last baby. Her milk is beginning to come in. Her breasts are full, and
her nipples are flat and become erect with stimulation.
My question is this--do I treat the mother and baby aggressively for yeast
at this point, or should I assume that her sore nipples are just due to the
baby's suck? What measures would you use for this patient? Other than
suck training, what is effective for such a strong suck? The mother did
not want to resort to pumping and using a SNS just yet. I have instructed
her to do suck training, pump before nursing to soften breasts, wear breast
shells, plus the normal measures for yeast. I have given her Chris Hafner-
Eaton's instructions for yeast, plus Kay Hoover's, but have not been
aggressive yet in that respect, as far as using Gentian Violet or anything
like that. I have told her to increase the acidophilus to 3x/day and to
stick her finger in the powder and let her baby suck on her finger. I also
told her to take Echinacea, Vit. C, avoid antibacterial soaps, boil pump
parts, use paper towels, etc.
I would appreciate the advice of anyone who has some suggestions I may not
have thought of. Also, our doctors are really hesitant to prescribe
Diflucan more than once. This mother is really committed to breastfeeding
and wants to make this work. Thank you.
Warmly,
Sharon Gollman, RN, BSN, IBCLC
Lenoir, NC
***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html
|
