I was contacted by NICU nurse because she wondered if the mother of a baby
in her care had mastitis.  I was on postpartum so just asked the mother to
come over to our ward and we could see her as an outpatient.  Baby was about
10 days old now, not latching, and for the previous 24 hours had not been
allowed to have physical contact with mother because he had conjunctivitis
which was being treated as bacterial, and she had purulently sore nipples.
She had sustained skin damage due to bad fit of pump flanges (and we don't
have any alternative sizes to use in the hospital).
On arrival she had all the classic signs and symptoms of mastitis, plus
blood work that suggested bacterial infection.  Culture was taken from the
pus on one nipple.  She had been running a fever for two days, and having
pain in one breast during that time.  Pumping much more than baby can
possibly consume, and was told to rest and get a full night's sleep without
pumping all night, the evening before I saw her, since she was so sore from
pumping.  Woke up in the morning with what could have turned into an abscess
if we had not gotten on top of it by then.

Why would anyone tell a mother who has all the major risk factors for
mastitis PLUS signs and symptoms of a fulminating case of same, to NOT
REMOVE ANY MILK for a period of nearly 10 hours?  The only thing they did
right was to call in the experts, but they could have done that at least 3
days sooner, and more like a week.

Arrgghh.  This goes right along with the kind of charting where it says
'baby feeding well' right next to where it says 'mother bleeding from
cracked nipples, given nipple salve', which also still occurs on my own
ward, even though we did make the grade for getting certified as
baby-friendly.  When we go to electronic charting I think I will see to it
that there is an automatic function in the charting program that makes such
a note impossible.

Rachel Myr
Kristiansand, Norway

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