I just want to check if this group concurs with my assessment of this
situation.  Please feel free to give me any and all feedback.
This mother is G2P2, with no issues with the first baby.  This baby, born at
full term developed dusky spells in the first 24 hours old and was admitted to
the Level II nursery, and placed on a monitor.  The mother has been
breastfeeding but the baby has been a poor feeder, so of course they have been bottle
feeding the baby with supplements (another story) and the mother was pumping
with a hospital grade pump.  The mother was discharged on day 3 and since we
thought this was going to be a short term issue, she opted to use her mini
electric pump at home when away from the baby.
On day 4 her mature milk was coming in but she never felt that the pump was
adequately emptying her breast.  When she was in the hospital she had the
hospital pump to use.  On day 6 (yesterday) she had been pumping at 3:30 AM at home
and noted from her left breast that the milk was very bloody.  She has
complained of achy, deep pain in that breast for the past 2 days.  The right breast
was fine, just full and then the 6:00 pumping was normal looking milk again.
When I saw her around 10:00 that day her breast have that "lumpy" feeling
from some of the ducts not fully emptying.  Nipples intact.  Hand expressing from
left breast, normal appearing milk.  The bottle she showed me had 30 cc of
very red milk.  When I asked her about the pumping at home she said she has been
using the pump on high suction because her breast have not been softening.
Now, this is my assessment; that the small pump on a high setting caused too
much pressure in the alveolus and rupture some capillaries giving the very
bloody milk.  Then these capillaries closed off and the next pumpings were normal
looking milk.  I also thought of this assessment by how mom feels between
pumpings and how she has been pumping.
I told her to lower the setting on pump, not to exceed 15 minutes of pumping,
and management of engorgement.  I am hoping the baby will be able to go home
today and she can go to all breastfeedings.
Should I have her call her OB about this and be examined?
Thanks for any feedback.
Happy Holidays!
Ann Perry RN, IBCLC
Boston, MA

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