Hi All,

I was hoping you could provide some suggestions/insight to help this poor 
mother I saw tonight, who gave permission to post.  Mom reported she is 
G2L2, delivered via C/S 8d ago.  She has only exclusively pumped for both 
babies.  Mom had an overabundant milk supply with her first baby and seems 
to have continued it with her new baby, pumping pints of milk in minutes 
each time.  She reported having occasional plugged ducts and mastitis with 
her first baby but overall it was an uneventful lactation.

Mom is currently pumping with a Lactina and standard 24mm flanges.  She 
said that pumping for her first baby was never uncomfortable, but this 
time it was painful, especially the first few minutes.  Over the phone 
this morning, I questioned the fit of her flanges but we were unable to 
conclude whether her flanges fit properly.  After further questioning, she 
realized that she had been misunderstanding the way her pump worked and 
actually had it set on the highest suction setting.  

She also described how, since this baby’s birth, she has been able to peel 
off a thick layer of tissue and debris from the face of her nipple every 
few days. She has been taking Ampicillin 500mg qid for the past 48h for a 
bladder infection.  

Other than these details, she felt that everything was going well, until 
last night.  She was pumping her breasts before bedtime and noticed that 
she had a firm lump directly behind her right nipple.  Pumping was even 
more painful in this breast, and she noticed she only expressed “about a 
teaspoon” from the affected breast.  She immediately contacted a lactation 
counselor (not IBCLC) who helped her through the night with no relief.  

By dawn when she called me, the pressure and pain was even more 
excruciating in the breast, and mom received little more than a trickle 
from the affected breast.  I explained RPS, hoping it might shift the 
swelling slightly, especially since she had been using such high suction 
and for nearly an hour at a time.  She wasn’t able to press on the areola 
without going through the roof.

By the time we spoke, she had scheduled an appointment mid-morning with an 
MD general practitioner.  She had no fever yet, but the fatigue from lack 
of sleep and pain made her feel very achey.  Since she was adverse to 
medication, I urged her to consider an offer for stronger antibiotics if 
her HCP advised them.  Until her appointment, I suggested moist heat, 
massage, and frequent pumping on a comfortable setting.  I also mentioned 
that lecithin can be quite helpful for this condition.

Mom called immediately after the appointment and said doc didn’t feel she 
had mastitis (yet) but prescribed her APNO.  Doc had no other suggestions 
for relief, despite the growing lumps and pressure in mom’s R breast.  Mom 
also reported that, by this time, lumps were starting to appear in her L 
breast as well.  I wasn’t able to see her until several hours later, 
during which she had even tried cold compresses on the right nipple and 
lecithin, with no relief.

When I got there, both of her nipples looked like Figure 154 in the 
Breastfeeding Atlas (page 73): bacterial infection with pus.  Both nipple 
faces seemed to have a thick yellow callous with pus underneath that would 
just not soften regardless of what mom tried.  Her R nipple had a lump 
directly behind it the size of a walnut but the L nipple was still 
reasonably pliable.  I’m guessing the severe trauma was caused by too 
small of pump flanges coupled with too high of pump suction.

I fitted her with larger flanges on both sides (settled on 30mm for both) 
and crossed my fingers that it would resolve all of her problems…but it 
didn’t.  She got little more than a trickle from the right and just a few 
ounces from her left.  The right breast was firm all the way to her chest 
wall.  I couldn’t even hand-express because of the excruciating lump 
behind the nipple that stretched it to the size of a quarter.  Every 
gentle touch and palpation caused this mom to jump and the tears flowed.  
She admitted she had been firmly committed to breastfeeding but this was 
too much for her to take.

I looked up Ampicillin in M&MM, which said that a standard adult dose was 
1,500 mg qid.  This mom was receiving 500mg qid.  I suggested she consult 
with her HCP about either taking a higher dose or getting a stronger 
antibiotic, as well as methods pain relief.  I suggested a thin layer of 
APNO on the nipple, followed by cabbage leaves (changed when wilted), 
followed by supportive bra, followed by cold packs while lying on her back 
to encourage drainage (20m on, 20m off).  I gave her information on ways 
of suppressing milk supply such as sage and peppermint.  I reassured her 
that, after her bladder infection and nipple infections and C/S incision 
were all healed, which should be in a very short time, she could un-quit.  
She was so relieved and thankful, although still in incredible pain and 
very emotional.

Okay…what did I miss?  What did I do wrong?  Help!!

Humbly,

Debbie Gillespie, IBCLC, LLLL
Tempe, AZ

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html