<<The 3rd mom is ready to stop breastfeeding any day now. Her pain is
unchanged with larger flanges, she is on Clindamycin for mastitis. I amd
not suspecting a yeast infection because the baby wasn't suckling and does
not have thrush. Mom did receive proph antibiotics for her c-secn.
She has been pumping every 2-3 hrs inspite of the pain but only manages to
get 1-2 oz each time. The milk does not flow/spray, it mostly just drips.
Her breasts are somewaht swollen, very lumpy and moderately tender. She is
also on fenugreek.

Please advice regarding mom#3. IS there anything I am missing?>>


Without knowing several details (age of baby?  how long was mom pumping with 
too small flanges? How long has she been using larger ones?  How long on 
antibiotic?)  I do have some thoughts...

First of all, if the skin is broken down where the nipple meets the areola, 
or even bright pink, she very well may have yeast overgrowth causing pain. 
Yeast often takes advantage of skin irritation from pump OR latch even in 
the absence of antibiotics, which this mom IS on.  Even if baby were at the 
breast, they very often have no visible thrush when mom is suffering from 
overgrowth. So if there is any redness or skin breakdown, I would try some 
gentian violet followed by clotrimazole.

Also, I would be sure she does not have the suction turned way up...use the 
lowest effective suction...maybe even take ibuprofen on a regular basis (400 
mg 4x/day) if pain is inhibiting her let-down.

I also wonder if the 30mm flanges are still too small for her because of the 
lumpiness you describe...there are the glass ones which I believe are even 
larger.

Lastly, I wonder about vasospasm...in my experience, vasospasm causes some 
of the most intense pain women describe.  If her worst pain is actually 
AFTER the pumping, covering her nipple up ASAP and applying a heating pad on 
"low" can be very helpful in breaking the cycle of 
spasm/hypoxia/damage/spasm.

Kathy Leeper, MD, IBCLC
Lincoln, NE

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