Just a warning, derived from my most recent client.

Add copious milk supply + nursing on only one side + returning to work at 3
months = (for this mother) repeated mastitis bouts.

Complication: mother is allergic to penicillins, so has been prescribed
other things (Keflex did not work, by the way).

Additional insult: mother never received (what I would consider) complete
instructions for effective pumping and was doing so only for 5 minutes
because in that time, she got all the milk she needed for the baby's
(missed from her) feedings.  She feeds baby directly at noon and pumps in
the AM and PM.

Suggested solutions? (Here is what I recommended)

a) pump long enough during hte day to feel softer and then gradually reduce
pumping time to reduce her milk production

b) offer second side rather than keeping baby on one side only so that
contralateral breast does not get so hard and uncomfortable (She was doing
this from lack of awareness of its effect when coupled with her clearly
more than abundant milk supply; baby was born 1 mo early and at 4 months,
as more than doubled his birthweight.  He now is over 17 lbs and has thighs
nearly as large as mom's)

c) stop waking baby up in the middle of the night to feed (due to breast
discomfort).  I suggested, instead, that she massage breasts if she feels
full enough to trigger milk ejection, but not to actively express or pump
and then return to bed.  If baby sleeps through, go for it.  (My goal here
is to reduce her nighttime supply just enough for her to remain
comfortable; I seriously doubt this baby would miss it.  If she doesn't
wake him, he continues to sleep.)


I view this case as a warning re: what can happen when a mother has a
copious supply and then misses feedings when she returns to work--even when
pumping.  It is a cautionary tale about the importance of good instructions
re: pumping when feeds must be missed, and how sometimes one-breast
feedings may not be as appropriate as they usually are.  (Note: I did not
ask her to switch according to the clock, but rather when baby comes off
(up for air) the first breast, to put him on second side rather than back
to first side.

Any other thoughts?

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Kathleen G. Auerbach,PhD, IBCLC (Ferndale, WA USA) [log in to unmask]
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