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Subject:
From:
Kathleen Bruce <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Fri, 27 Sep 1996 19:45:37 -0400
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This comes to me from a colleague in Southern Vermont:

Client is 20 weeks pregnant. Client has a hx of primary herpes breast
infection on her areola, 8 yrs ago.  Client is trying to get her med records
to see if a culture was done at the time.  No lesions since.

Nurse/midwife  is familiar with Lawrence's info, and with Riordan/Auerbach info.
Lawrence p 486, and Riordan/Auerbach p. 172.

QUESTIONS:

1. If mom has had a herpes infection of one breast, is she susceptible to
recurrent infection on one or both breasts?

2. Is it possible for people to shed virus before the vesicle forms.? "The
local lesions may be preceded by mild irritation or burning at the local
site or by severe neuralgic pain in the region. " Nelson Textbook of
Pediatrics 13 th edition, Behrman and Vaughan, Saunders, 1987, p. 662.

In the early days of bf, many women have transient nipple tenderness. I am
concerned (says the midwive who asks this) about possibility of a mother not
recognizing that she is having a recurrence of her herpes and her baby being
inadvertently infected, espec if she is shedding virus before she has a
clearly recognizable herpes lesion. At the other end of the spectrum, is
concern that mother may be so worried about possibility of infection her
baby that she is unable to enjoy bf.

3. When does the infact develop immunocompentence so that the risk of
acquiring herpes is not life threatening?

One would like to be able to tell mother when she can relax a bit.  This is
not to suggest she would purposely infect her infant. It also present a
teachable opportunity to inform mother than any sexual contact with the
lesion on her breast could infect her partner.

4. is there any further information about reports of the possibility of
herpes virus in human milk?  Is this more likely to occur in primary
infection? Does an aereolar breast lesion increase the chance of finding
virus in human milk?

HYPOTHETICAL CARE PLAN FOR THIS MOTHER:

a. Nurse on both breasts as long as there are no active lesions.
b. If you develop a breast lesion, d/c bf on the breast with the lesion.

Continue to feed baby on unaffected breast.  Use freq hand washing espec if
you touch lesion. Make sure that any family memebers who touch lesion wash
hands well. Cover lesion with dressing before bf on the unaffected breast.
If using disposable breast pads, discard carefully and wash hands
well...espec after touching the pad or any article of clothing that has
direct contact with lesion.  Pump to maintain milk supply.  ALl pump parts
that come in contact with milk or breast must be sterilized. Wash in hot
water with soap. Finse . Boil in large pot of water so that parts are free
floating, and so that water will not evaporate during sterilization.  Boil
pump parts 20 min.  ALthough your breastmilk does not have herpes virus in
it, the milk you are pumping may be contaminated by the lesion on the
breast.  Any breastmilk collected will be discarded until lesion is
completely healed.

-----------------------------

Please comment on this situation/care plan to the list, and to me personally
via e-mail, and I will forward to the midwife. Thanks .

Kathleen

Kathleen B. Bruce, BSN, IBCLC co-owner Lactnet,Corgi-L,TLC, Indep. Consultant
http://together.net/~kbruce/kbbhome.html
LACTNET Archives http://library.ummed.edu/lsv/archives/lactnet.html

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