To all--
I have a new mom who delivered 1/20 via planned cesarean section due to the
history of myasthenis gravis.  Baby ended up in special care due to some
wet lungs for 2 days.  Difficulty in nursing so started to pump -- stated
milk came in on the 3rd day post partum.  On 1/27, mom ended up with 104
fever and saw MD on 1/28. cultures were done of surgery wound, cervical and
breast exam was done by a breastfeeding friendly ob.  Started on
antibiotics and I was called to see her the next day.  The breasts were
engorged with redness dependent, almost to the nipple line.  HEr fever
continued even with ibuprofen and tylenol.  Her pumping history was every 2-
3 hours for 30 minutes!  The most milk expressed was 60 cc/pumping.  Left
breast expressed 20-40cc/ right 10-20.  We started on cabbage and pumping
every 2-3 hours but for 10-15 minutes only.  Baby had a very tight mouth
with a humped tongue.  Two grandmoms were present at all times to "help".
They didn't want the milk to be given to the baby as it was "bad" and when
baby was at the breast, attempting to latch on, grandmoms would interrupt
as baby "doesn't want it."  Mom was too sick to fight with these two very
strong women.  She contines today 2/3 with a fever spike to 101 at bedtime,
fine throughout the day.  She continues to pump on a regular schedule,
however the expressed milk is less than 5cc on left side and just a
glistening nipple on the right.  Breasts are lumpy but soft, hand
expression was possible but caused some pain to the mom.  No use of cabbage
since the first night, no drug use other than anti-inflammatories and
antibiotics.  All cultures came back negative.  Mom's goal is to continue
to pump without any actual nursing as she needs to go back to work.  I
don't want to encourage with herbs a milk supply too diligently as I'm
concerned about the continued fevers and the difficulty with let down.
Would you consider oxytocin spray?  The mom continues to be tense and just
basically doesn't feel well.  Not sure where to go from here.  Any
suggestions?  Thanks in advance,
Carol Chornock

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