I have permission to post and I apologize for the length.  I hate to leave anything out hoping any detail could help you help me shed some light;

I have been working with an older primip who delivered 6 weeks ago.  The first time I saw her was in the office 1 week after.  In the hospital baby was feeding well on assessment but mom did complain of sore nipples.  Tips were given.  By the office visit at 1 week of age, Mom had taken baby off breast due to sore nipples and had started pumping.  She was using a "retailer brand" pump and it had torn her nipples up to where they were bleeding.  I helped mom with position and latch and was able to get baby onto the right breast with minimal pain but the left breast was still very painful even with proper latching.  Mom was ready to quit breastfeeding so I used a nipple shield to give mom a buffer between her and baby and this helped.  Another problem mom had was baby never came off breast when she was finished so mom would have to take her off. This sweet little angel would clamp down and mom would have to pry her off her breast and cry out in pain as she would take her off breast.  She ended up having to push her gum upward to get her off because pushing her gum down did not work.  After about a week the left breast heeled up and mom was able to breastfeed without the nipple shield.  While her nipples were cracked I had her using triple antibiotic ointment to the tips of her nipples to help them heal and help with infection.  Two weeks later mom and baby come back to clinic and they are breastfeeding well but pain is different.  It is now a burning type pain.  Nipples were no longer bleeding.  Baby had thrush and mom probably had yeast on her nipples.  Both were referred to their health care providers.  At this point mom was giving baby a 3 ounce bottle of formula at night to help her sleep at night.  She said the preferred to do this because she liked getting more sleep and this was how she felt she could best get it. Nothing I could say made a difference so she continued to do this.  I didn't hear from this mom again until 6/21 when she came into my office about 0830 telling me that something in her breast had burst.  She let down her flap, removed her breast pad and she had a hole in her breast the size of a half dollar that was oozing pus.  Her breast looked like there was a clear piece of opsite on it.  (for you non nurses that is a clear transparent piece of material). I could see through her skin and I could see an abscess the size of a baseball.  She had never had mastitis, any fever, never had flu like symptoms.  Symptoms started as a knot 3 weeks ago that she thought was milk.  She massaged and worked with the area thinking she was helping to move the milk.  She saw her doctor the Thursday before the abscess ruptured and he had scheduled her for a sonogram of the breast on the Monday it ruptured. I have only seen 2 abscesses in my 15 years and the others started with mastitis.  I would like to hear from anyone who has seen anything like this to see if I missed anything.  Please e-mail me off line.

Thanks,
Debra Knight, RN, IBCLC

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